Provider Demographics
NPI:1396408514
Name:GOGEL, KATIE MARIE (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:GOGEL
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13139 N COUNTY ROAD 1450 E
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IN
Mailing Address - Zip Code:47588-9653
Mailing Address - Country:US
Mailing Address - Phone:812-549-6012
Mailing Address - Fax:
Practice Address - Street 1:1939 GOLDSMITH LN STE 117
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3176
Practice Address - Country:US
Practice Address - Phone:502-384-5436
Practice Address - Fax:502-530-8046
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011722A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71011722AOtherINDIANA APRN LICENSURE
KY3016927OtherKENTUCKY APRN LICENSURE