Provider Demographics
NPI:1811538846
Name:CORDER, KITRA (RN)
Entity Type:Individual
Prefix:
First Name:KITRA
Middle Name:
Last Name:CORDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 S EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-6933
Mailing Address - Country:US
Mailing Address - Phone:765-993-4040
Mailing Address - Fax:
Practice Address - Street 1:1040 E 86TH ST STE 46H
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1857
Practice Address - Country:US
Practice Address - Phone:317-669-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28178664A163WH0200X, 163WW0000X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care