Provider Demographics
NPI:1508578451
Name:ROMINE, KATLYN M (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KATLYN
Middle Name:M
Last Name:ROMINE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3328 S 900 W
Mailing Address - Street 2:
Mailing Address - City:MENTONE
Mailing Address - State:IN
Mailing Address - Zip Code:46539-9347
Mailing Address - Country:US
Mailing Address - Phone:219-869-4688
Mailing Address - Fax:
Practice Address - Street 1:738 E 200 N
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46582-7857
Practice Address - Country:US
Practice Address - Phone:574-221-6334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013408A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily