Provider Demographics
NPI:1174162754
Name:VARNER, KATINA A (DNP, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:KATINA
Middle Name:A
Last Name:VARNER
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12445 PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8072
Mailing Address - Country:US
Mailing Address - Phone:219-433-6749
Mailing Address - Fax:
Practice Address - Street 1:12445 PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8072
Practice Address - Country:US
Practice Address - Phone:219-433-6749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2019050545363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty