Provider Demographics
NPI:1598587057
Name:BARTTRUM, KURT
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:BARTTRUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9865 E 116TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9238
Mailing Address - Country:US
Mailing Address - Phone:765-234-6463
Mailing Address - Fax:855-631-0690
Practice Address - Street 1:9865 E 116TH ST STE 300
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9238
Practice Address - Country:US
Practice Address - Phone:765-234-6463
Practice Address - Fax:855-631-0690
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71016813A363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health