Healthcare Provider Details

I. General information

NPI: 1659235380
Provider Name (Legal Business Name): KAITLYN MICHELE CARR PA-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE CARR

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 CAMPBELL ST
VALPARAISO IN
46385-3452
US

IV. Provider business mailing address

1204 CAMPBELL ST
VALPARAISO IN
46385-3452
US

V. Phone/Fax

Practice location:
  • Phone: 815-592-0830
  • Fax:
Mailing address:
  • Phone: 815-592-0830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: