Provider Demographics
NPI:1265662076
Name:MCGOVERN, KATHRYN M (NP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CAMBY CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-4085
Mailing Address - Country:US
Mailing Address - Phone:317-881-8737
Mailing Address - Fax:317-881-8735
Practice Address - Street 1:401 CAMBY CT
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-4085
Practice Address - Country:US
Practice Address - Phone:317-881-8737
Practice Address - Fax:317-881-8735
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMM1987164363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics