MEDICARE: KATELYN NICOLE CUSTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	71016933A	IN

General Provider Information

NPI Number	:	1386432763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN NICOLE CUSTER

Provider Business Mailing Address
First Line	:	2461 MEADOW BEND DR
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-1438
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7230 ARBUCKLE CMNS STE 203
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-1795
Country	:	US
Telephone Number	:	317-207-0273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2025
Last Update Date	:	08/12/2025

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Directions to “ KATELYN NICOLE CUSTER ” Practice Location

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