Individual
KATELYN DYKSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
901 MACARTHUR BLVD, MUNSTER, IN 46321-2901
(219) 392-7466
(219) 392-7470
Mailing address
8558 BROADWAY, MERRILLVILLE, IN 46410-7032
(219) 392-7084
(219) 703-6854
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71015159A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300088943
—
IN
Enumeration date
02/16/2024
Last updated
04/30/2024
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