Healthcare Provider Details

I. General information

NPI: 1447241179
Provider Name (Legal Business Name): KRISTIN JOY KILE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 MEMORIAL DR STE 403
SOUTH BEND IN
46601-1063
US

IV. Provider business mailing address

3245 HEALTH DRIVE SUITE 100
GRANGER IN
46530-3245
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-1405
  • Fax:
Mailing address:
  • Phone: 574-647-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number7200053A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: