Provider Demographics
NPI:1376859967
Name:WEHRLE, KATHY L (RD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:WEHRLE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11055 TWIN CREEKS CV
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-2204
Practice Address - Country:US
Practice Address - Phone:260-425-6120
Practice Address - Fax:260-425-6115
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000439A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000675919OtherANTHEM -NEOB/GYN
IN000000675940OtherANTHEM PFC
IN000000675940OtherANTHEM PFC
INM400023060Medicare PIN