Healthcare Provider Details

I. General information

NPI: 1386817559
Provider Name (Legal Business Name): KATHERINE B RIEDFORD PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 S STOCKWELL RD
EVANSVILLE IN
47714-0247
US

IV. Provider business mailing address

415 MULBERRY STREET
EVANSVILLE IN
47713-1230
US

V. Phone/Fax

Practice location:
  • Phone: 812-476-5437
  • Fax: 812-422-7558
Mailing address:
  • Phone: 812-423-7791
  • Fax: 812-422-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71002619A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: