Healthcare Provider Details

I. General information

NPI: 1528835436
Provider Name (Legal Business Name): ALAYNA LYNN KITCHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11050 PARKVIEW CIRCLE DR
FORT WAYNE IN
46845-1739
US

IV. Provider business mailing address

11050 PARKVIEW CIRCLE DR
FORT WAYNE IN
46845-1739
US

V. Phone/Fax

Practice location:
  • Phone: 833-724-8326
  • Fax: 260-425-6845
Mailing address:
  • Phone: 833-724-8326
  • Fax: 260-425-6845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71015178A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number28264499A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: