Provider Demographics
NPI:1780766972
Name:CALLAHAN, KATHERINE VERONICA (RN, MSN, CNS, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:VERONICA
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:RN, MSN, CNS, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 E PENDLETON AVE # 547
Mailing Address - Street 2:
Mailing Address - City:LAPEL
Mailing Address - State:IN
Mailing Address - Zip Code:46051-5546
Mailing Address - Country:US
Mailing Address - Phone:765-534-3636
Mailing Address - Fax:
Practice Address - Street 1:299 E PENDLETON AVE # 547
Practice Address - Street 2:
Practice Address - City:LAPEL
Practice Address - State:IN
Practice Address - Zip Code:46051-5546
Practice Address - Country:US
Practice Address - Phone:765-534-3636
Practice Address - Fax:765-534-3638
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002634A363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100171430Medicaid
IN15D2075563OtherCLIA
ININ1868002OtherMEDICARE
IN1780766972OtherNPI
IN000000888757OtherANTHEM
IN200899550Medicaid
200311740JOtherHPN MCD GRP# & LOCATION CODE
IN15D2075563OtherCLIA
INM400071049Medicare PIN