Healthcare Provider Details

I. General information

NPI: 1861855090
Provider Name (Legal Business Name): KAITLIN CHRISTINE WEBB PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11055 BROADWAY
CROWN POINT IN
46307-9177
US

IV. Provider business mailing address

106 E THOMPSON ST
RENSSELAER IN
47978-3132
US

V. Phone/Fax

Practice location:
  • Phone: 219-797-7463
  • Fax:
Mailing address:
  • Phone: 317-701-8812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10003382A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: