Healthcare Provider Details

I. General information

NPI: 1467989533
Provider Name (Legal Business Name): KATHLEEN ANN MUNNING APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 SAINT CHARLES ST STE 4
JASPER IN
47546-9172
US

IV. Provider business mailing address

PO BOX 1028
JASPER IN
47547-1028
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-9555
  • Fax: 812-482-9073
Mailing address:
  • Phone: 812-996-8478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71007314A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: