Provider Demographics
NPI:1275106288
Name:CORPE, KATLYN DANIELLE (FAMILY NP)
Entity Type:Individual
Prefix:MRS
First Name:KATLYN
Middle Name:DANIELLE
Last Name:CORPE
Suffix:
Gender:F
Credentials:FAMILY NP
Other - Prefix:
Other - First Name:KATLYN
Other - Middle Name:DANIELLE
Other - Last Name:ROSINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2316 NUTTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46809-1202
Mailing Address - Country:US
Mailing Address - Phone:260-409-3997
Mailing Address - Fax:
Practice Address - Street 1:333 S MADISON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47305-2465
Practice Address - Country:US
Practice Address - Phone:765-286-7000
Practice Address - Fax:765-213-2769
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28235248A163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
INF05210566OtherFAMILY NURSE PRACTITIONER CERTIFICATION