Provider Demographics
NPI:1306033063
Name:DILDINE, KATHRYN (NURSE PRACTIONER)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:DILDINE
Suffix:
Gender:F
Credentials:NURSE PRACTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 W JEFFERSON ST
Mailing Address - Street 2:STE S200
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2140
Mailing Address - Country:US
Mailing Address - Phone:317-738-0630
Mailing Address - Fax:317-738-0737
Practice Address - Street 1:1125 W JEFFERSON ST
Practice Address - Street 2:STE S200
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2140
Practice Address - Country:US
Practice Address - Phone:317-346-7934
Practice Address - Fax:317-738-0737
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28066212A363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200871750Medicaid
IN28066212AOtherLICENSE
IN253810003Medicare UPIN