Healthcare Provider Details

I. General information

NPI: 1194638080
Provider Name (Legal Business Name): KATLIN KNOX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATLIN SULLIVAN

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MACARTHUR BLVD STE 405
MUNSTER IN
46321-2919
US

IV. Provider business mailing address

801 MACARTHUR BLVD STE 405
MUNSTER IN
46321-2919
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-5167
  • Fax: 219-836-5249
Mailing address:
  • Phone: 219-836-5167
  • Fax: 219-836-5249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28185500A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: