Provider Demographics
NPI:1750053526
Name:O'FARRELL, KATE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:O'FARRELL
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 1:3691 KINGSWAY DR
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8936
Mailing Address - Country:US
Mailing Address - Phone:219-218-3474
Mailing Address - Fax:
Practice Address - Street 1:9150 E 109TH AVE STE 2A
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7686
Practice Address - Country:US
Practice Address - Phone:219-226-1529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011540A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner