Healthcare Provider Details

I. General information

NPI: 1811831704
Provider Name (Legal Business Name): MCKENZIE KATHRYN FISH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 NORTHWESTERN AVE
WEST LAFAYETTE IN
47906-2975
US

IV. Provider business mailing address

714 BUCHANAN ST APT 4
INDIANAPOLIS IN
46203-1026
US

V. Phone/Fax

Practice location:
  • Phone: 844-787-3834
  • Fax:
Mailing address:
  • Phone: 770-377-2109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2025093387
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: