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NPI Code Detail

MEDICARE: YOUR CORNER PEDIATRICS, LLC

MEDICARE: YOUR CORNER PEDIATRICS, LLC
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
1363LP0200XPediatric Nurse Practitioner

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11265662076OTHERINNPI NUMBER
21659923761OTHERINNPI NUMBER

General Provider Information

NPI Number : 1871368134
Entity Type Code : Organization
Provider Name (Legal Business Name) : YOUR CORNER PEDIATRICS, LLC
Provider Business Mailing Address
First Line : 819 E 64TH ST STE 103
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46220-1657
Country : US
Telephone Number : 317-676-9943
Fax Number : 317-943-9892
Provider Business Practice Location Address
First Line : 819 E 64TH ST STE 103
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46220-1657
Country : US
Telephone Number : 317-676-9943
Fax Number : 317-943-9892
Authorized Official
Title or Position : OWNER
Name : KATHRYN MCGOVERN
Credential : NP
Telephone Number : 317-676-9943
Provider Enumeration Date : 11/16/2023
Last Update Date : 11/16/2023

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Directions to “YOUR CORNER PEDIATRICS, LLC ” Practice Location

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