Provider Demographics
NPI:1568181303
Name:CARBY, CATHY-ANN NIKEISHA (NP)
Entity Type:Individual
Prefix:
First Name:CATHY-ANN
Middle Name:NIKEISHA
Last Name:CARBY
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 1:11415 CEDARMONT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-1951
Mailing Address - Country:US
Mailing Address - Phone:407-456-2840
Mailing Address - Fax:
Practice Address - Street 1:255 N MIAMI ST
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-2705
Practice Address - Country:US
Practice Address - Phone:260-563-8446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28247227A163W00000X
IN71014898A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty