Provider Demographics
NPI:1982314340
Name:LANGEBRAKE, KATLYN (NP)
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:
Last Name:LANGEBRAKE
Suffix:
Gender:F
Credentials:NP
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 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-450-6966
Mailing Address - Fax:
Practice Address - Street 1:647 W 2ND ST STE B
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3243
Practice Address - Country:US
Practice Address - Phone:812-477-6103
Practice Address - Fax:812-469-3285
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013267A363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily