Provider Demographics
NPI:1306897913
Name:SANTON, KATHY (APRN, BC)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:SANTON
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 N STATE ROAD 267
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9513
Mailing Address - Country:US
Mailing Address - Phone:317-268-6555
Mailing Address - Fax:317-268-6556
Practice Address - Street 1:192 N STATE ROAD 267
Practice Address - Street 2:SUITE 300
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9513
Practice Address - Country:US
Practice Address - Phone:317-268-6555
Practice Address - Fax:317-268-6556
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000050A364SP0808X
IN700000J0A163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200078540Medicaid
IN200078540Medicaid