Provider Demographics
NPI:1700122579
Name:ATKINS, RENAE CHARLENE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:RENAE
Middle Name:CHARLENE
Last Name:ATKINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E CULVER RD STE 106
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:IN
Mailing Address - Zip Code:46534-2241
Mailing Address - Country:US
Mailing Address - Phone:574-772-7400
Mailing Address - Fax:574-772-0299
Practice Address - Street 1:104 E CULVER RD STE 106
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-2241
Practice Address - Country:US
Practice Address - Phone:574-772-7400
Practice Address - Fax:574-772-0299
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-21
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004294A363LF0000X
IN28164138A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily