Healthcare Provider Details

I. General information

NPI: 1174130611
Provider Name (Legal Business Name): KATHERINE EDNEY WATSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE ANN EDNEY

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 INDIAN BOUNDARY RD STE 200
CHESTERTON IN
46304-1519
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 219-921-2000
  • Fax: 219-395-8770
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71010412A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: