Healthcare Provider Details

I. General information

NPI: 1104642289
Provider Name (Legal Business Name): KATRINA STOWERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2024
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N GREEN ST STE 402
BROWNSBURG IN
46112-2115
US

IV. Provider business mailing address

7042 BLUFFRIDGE BLVD
INDIANAPOLIS IN
46278-1845
US

V. Phone/Fax

Practice location:
  • Phone: 317-852-3690
  • Fax:
Mailing address:
  • Phone: 317-502-8141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71017917A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: