Provider Demographics
NPI: | 1467875948 |
---|---|
Name: | HILGER, KAITLIN (NP) |
Entity Type: | Individual |
Prefix: | |
First Name: | KAITLIN |
Middle Name: | |
Last Name: | HILGER |
Suffix: | |
Gender: | F |
Credentials: | NP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 10021 DUPONT CIRCLE COURT |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT WAYNE |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46825-1604 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 260-426-8117 |
Mailing Address - Fax: | 260-420-0817 |
Practice Address - Street 1: | 10021 DUPONT CIRCLE COURT |
Practice Address - Street 2: | |
Practice Address - City: | FORT WAYNE |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46825-1604 |
Practice Address - Country: | US |
Practice Address - Phone: | 260-426-8117 |
Practice Address - Fax: | 260-420-0817 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2014-02-04 |
Last Update Date: | 2016-03-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 71004781A | 363LA2200X, 363LG0600X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No | 363LG0600X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 201214430 | Medicaid |