Provider Demographics
NPI:1194775544
Name:ZAWODNIAK, KASEY JO (RN, CPNP-AC)
Entity type:Individual
Prefix:MS
First Name:KASEY
Middle Name:JO
Last Name:ZAWODNIAK
Suffix:
Gender:F
Credentials:RN, CPNP-AC
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:
Other - Last Name:KOCHINSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-948-0944
Practice Address - Fax:317-274-2940
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013463A363LP0200X
MO146725363LP0222X
NC5018437363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO146725OtherLICENSCE
TX774507OtherRN LICENSE