Provider Demographics
NPI:1831497098
Name:KORTZENDORF, KATHRYN A (NP)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:A
Last Name:KORTZENDORF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:A
Other - Last Name:ASHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1466 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1800
Mailing Address - Country:US
Mailing Address - Phone:317-873-6438
Mailing Address - Fax:
Practice Address - Street 1:1616 LEERKAMP DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-9083
Practice Address - Country:US
Practice Address - Phone:317-679-1536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28082355A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily