Provider Demographics
NPI:1225592843
Name:TINIUS, KAITLYN (NP)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:TINIUS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:LANGSDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1115 RONALD REAGAN PKWY STE 171
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6914
Practice Address - Country:US
Practice Address - Phone:317-217-2888
Practice Address - Fax:317-217-2999
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008716A363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care