Provider Demographics
NPI:1275797847
Name:KOLTHOFF, KAY LYNN (RN FAMILY NURSE PRAC)
Entity Type:Individual
Prefix:MS
First Name:KAY
Middle Name:LYNN
Last Name:KOLTHOFF
Suffix:
Gender:F
Credentials:RN FAMILY NURSE PRAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:1600 ALBANY STREET
Mailing Address - Street 2:
Mailing Address - City:BEECH GROVE
Mailing Address - State:IN
Mailing Address - Zip Code:46107
Mailing Address - Country:US
Mailing Address - Phone:317-782-7562
Mailing Address - Fax:317-782-6145
Practice Address - Street 1:1600 ALBANY STREET
Practice Address - Street 2:
Practice Address - City:BEECH GROVE
Practice Address - State:IN
Practice Address - Zip Code:46107
Practice Address - Country:US
Practice Address - Phone:317-782-7562
Practice Address - Fax:317-782-6145
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28100125A163W00000X
IN71001059A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily