Healthcare Provider Details

I. General information

NPI: 1548091333
Provider Name (Legal Business Name): KAITLIN ROSE MANN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 S REED RD STE 108
KOKOMO IN
46902-3828
US

IV. Provider business mailing address

3611 S REED RD STE 108
KOKOMO IN
46902-3828
US

V. Phone/Fax

Practice location:
  • Phone: 219-218-6255
  • Fax:
Mailing address:
  • Phone: 219-218-6255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71017142B
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71017142A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28258914C
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95332056
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28258914A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: