Provider Demographics
NPI:1144984618
Name:SIEVERT, KATHLEEN ANN (FNP-C)
Entity type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:ANN
Last Name:SIEVERT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12030 ZIRCON LN UNIT 300
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-5446
Mailing Address - Country:US
Mailing Address - Phone:219-422-2042
Mailing Address - Fax:
Practice Address - Street 1:40 N RANGELINE RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1741
Practice Address - Country:US
Practice Address - Phone:317-989-8463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012326A363LF0000X
IN28236339A163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency