Healthcare Provider Details

I. General information

NPI: 1104267806
Provider Name (Legal Business Name): CORIANNE WARRICK VANDERKOLK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORRIANNE SMITH WARRICK

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 A ST NE STE 9
LINTON IN
47441
US

IV. Provider business mailing address

1600 A ST NE STE 9
LINTON IN
47441-1612
US

V. Phone/Fax

Practice location:
  • Phone: 812-699-4153
  • Fax: 812-699-4271
Mailing address:
  • Phone: 812-847-7005
  • Fax: 812-847-5309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10001546
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: