Provider Demographics
NPI:1538314356
Name:EVERDING, KATINA A (NP)
Entity type:Individual
Prefix:
First Name:KATINA
Middle Name:A
Last Name:EVERDING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATINA
Other - Middle Name:A
Other - Last Name:MCKAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2484 S BUSINESS 31
Mailing Address - Street 2:SUITE C
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-7312
Mailing Address - Country:US
Mailing Address - Phone:765-472-2722
Mailing Address - Fax:765-472-2722
Practice Address - Street 1:2484 S BUSINESS 31
Practice Address - Street 2:SUITE C
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-7312
Practice Address - Country:US
Practice Address - Phone:765-472-2722
Practice Address - Fax:765-472-2722
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002806A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201163600Medicaid
IN940590004Medicare PIN