Healthcare Provider Details

I. General information

NPI: 1508136391
Provider Name (Legal Business Name): KAITLYN DALE OGDEN A-GNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W CARMEL DR STE 110
CARMEL IN
46032-2502
US

IV. Provider business mailing address

650 W CARMEL DR STE 110
CARMEL IN
46032-2502
US

V. Phone/Fax

Practice location:
  • Phone: 317-595-5698
  • Fax:
Mailing address:
  • Phone: 317-595-5698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2427
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71013251A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number058
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: