Provider Demographics
NPI:1952329252
Name:BRINEGAR, KATHRYN PAIGE (NP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:PAIGE
Last Name:BRINEGAR
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 1:3333 KESSLER BLVD NORTH DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-1888
Mailing Address - Country:US
Mailing Address - Phone:317-328-2269
Mailing Address - Fax:
Practice Address - Street 1:395 WESTFIELD RD
Practice Address - Street 2:RIVERVIEW HOSPITAL
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1425
Practice Address - Country:US
Practice Address - Phone:317-776-7407
Practice Address - Fax:317-776-7361
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28129606A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28129606AOtherIN LICENSE NUMBER
IN000000260496OtherBLUE CROSS BLUE SHIELD #
INTB5050Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
IN000000260496OtherBLUE CROSS BLUE SHIELD #