Provider Demographics
NPI:1316934490
Name:MUTH, CATHERINE ANN (ARNP)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:ANN
Last Name:MUTH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4123 DUTCHMANS LN STE 102
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4718
Practice Address - Country:US
Practice Address - Phone:502-559-1670
Practice Address - Fax:502-559-1679
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001861A363LF0000X
KY3003861363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50128159OtherPASSPORT
IN200412070Medicaid
KY000001087569OtherANTHEM
KY019300OtherSIHO
KYK087131OtherMEDICARE
IN300002914Medicaid
KY78008927Medicaid
IN200412070Medicaid
KYK000441Medicare PIN
KYK087131OtherMEDICARE
KY50128159OtherPASSPORT
IN300002914Medicaid