Provider Demographics
NPI:1285353979
Name:FERNANDEZ, KATHERINE MARGARET (NP)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MARGARET
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:KATHERINE
Other - Middle Name:MARGARET
Other - Last Name:LEPLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1818 CAREW ST STE 240
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4764
Practice Address - Country:US
Practice Address - Phone:260-425-5900
Practice Address - Fax:260-425-5925
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28215798A163WG0000X
IN71013125A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice