Individual
KAY L. CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1205 PROVIDENT DR STE A, WARSAW, IN 46580-3265
(574) 371-2578
(574) 371-2580
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3513
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71002398A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200874080
—
IN
Enumeration date
06/29/2007
Last updated
09/22/2021
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