Individual
MS. KATHLEEN M WHITAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNS
Contact information
Practice address
209 W NORTH ST, LEBANON, IN 46052
(765) 481-2015
(765) 481-2270
Mailing address
209 W. NORTH ST, LEBANON, IN 46052
(765) 481-2015
(765) 481-2270
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
28056006A
IN
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
28056006A
IN
364S00000X
Clinical Nurse Specialist
70000213
IN
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
70000213
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200983160
—
IN
Enumeration date
11/06/2008
Last updated
04/09/2015
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