Provider Demographics
NPI:1093235400
Name:STEPHENSON, KATHRYNE WALES (DNP CPNP)
Entity Type:Individual
Prefix:
First Name:KATHRYNE
Middle Name:WALES
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:DNP CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 CLEARVISTA PKWY
Mailing Address - Street 2:STE 185
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-5605
Mailing Address - Country:US
Mailing Address - Phone:317-621-9000
Mailing Address - Fax:
Practice Address - Street 1:8101 CLEARVISTA PKWY STE 185
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-5605
Practice Address - Country:US
Practice Address - Phone:317-621-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28177321A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics