Provider Demographics
NPI:1174911713
Name:OTT, KIMBERLY A (FNP-C)
Entity type:Individual
Prefix:MR
First Name:KIMBERLY
Middle Name:A
Last Name:OTT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:KOPPEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10342 N 100 W
Mailing Address - Street 2:
Mailing Address - City:WHEATFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46392-9704
Mailing Address - Country:US
Mailing Address - Phone:866-434-3255
Mailing Address - Fax:855-238-6151
Practice Address - Street 1:10342 N 100 W
Practice Address - Street 2:
Practice Address - City:WHEATFIELD
Practice Address - State:IN
Practice Address - Zip Code:46392-9704
Practice Address - Country:US
Practice Address - Phone:866-434-3255
Practice Address - Fax:855-238-6151
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28143248A363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care