Provider Demographics
NPI:1508136391
Name:OGDEN, KAITLYN DALE (A-GNP-C)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:DALE
Last Name:OGDEN
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 W CARMEL DR STE 110
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2502
Mailing Address - Country:US
Mailing Address - Phone:317-595-5698
Mailing Address - Fax:
Practice Address - Street 1:650 W CARMEL DR STE 110
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2502
Practice Address - Country:US
Practice Address - Phone:317-595-5698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24272255A2300X
IN71013251A363L00000X
WY0582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer