Provider Demographics
NPI:1497052336
Name:KURTH, KATHRYN H (CPNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:H
Last Name:KURTH
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:H
Other - Last Name:METZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1026
Mailing Address - Country:US
Mailing Address - Phone:317-777-6435
Mailing Address - Fax:317-777-6644
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-944-2143
Practice Address - Fax:317-944-3107
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010490363L00000X
IN281675786A363LP0200X
IN71003562363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201015490Medicaid
INM400040261Medicare PIN