Healthcare Provider Details

I. General information

NPI: 1447822036
Provider Name (Legal Business Name): KATHERINE KIMMEL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5026 W US 52
NEW PALESTINE IN
46163-9770
US

IV. Provider business mailing address

2320 CUNNINGHAM RD
INDIANAPOLIS IN
46224-3702
US

V. Phone/Fax

Practice location:
  • Phone: 317-861-4838
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71011588A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: