Healthcare Provider Details

I. General information

NPI: 1770952582
Provider Name (Legal Business Name): KATHY NOBLES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 FRANKLIN ST SUITE 200
MICHIGAN CITY IN
46360-3563
US

IV. Provider business mailing address

2401 VALLEY DR
VALPARAISO IN
46383-2520
US

V. Phone/Fax

Practice location:
  • Phone: 888-580-1060
  • Fax: 219-879-2915
Mailing address:
  • Phone: 888-580-1060
  • Fax: 219-465-9507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2820452A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: