Healthcare Provider Details

I. General information

NPI: 1144984618
Provider Name (Legal Business Name): KATHLEEN ANN SIEVERT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 N RANGELINE RD
CARMEL IN
46032-1741
US

IV. Provider business mailing address

12030 ZIRCON LN UNIT 300
FISHERS IN
46038-5446
US

V. Phone/Fax

Practice location:
  • Phone: 317-989-8463
  • Fax:
Mailing address:
  • Phone: 219-422-2042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71012326A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number28236339A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: