Provider Demographics
NPI:1316697139
Name:GAHAGEN, KATLYN MORGAN (PA-C)
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:MORGAN
Last Name:GAHAGEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATLYN
Other - Middle Name:
Other - Last Name:KEELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:515 BOB JONES WAY, ROOM 3001
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47708
Mailing Address - Country:US
Mailing Address - Phone:812-488-3400
Mailing Address - Fax:
Practice Address - Street 1:9365 COUNSELORS ROW STE 210
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-6418
Practice Address - Country:US
Practice Address - Phone:317-429-0120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
IN10003676A207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant