Provider Demographics
NPI:1447241179
Name:KILE, KRISTIN JOY (CNM)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:JOY
Last Name:KILE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 HEALTH DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-3245
Mailing Address - Country:US
Mailing Address - Phone:574-647-1840
Mailing Address - Fax:
Practice Address - Street 1:621 MEMORIAL DR
Practice Address - Street 2:STE 403
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1063
Practice Address - Country:US
Practice Address - Phone:574-647-1405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN7200053A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200305340Medicaid
IN236040260OtherMEDICARE PTAN
IN000000704691OtherANTHEM MIDWIFERY
IN000000781234OtherBCBS BMG SOUTHEAST
INM400020899Medicare PIN
IN000000667505OtherBCBS BMG CENTRAL
IN000000704691OtherANTHEM MIDWIFERY
INP15804Medicare UPIN