Provider Demographics
NPI:1174934780
Name:MOTLEY, KATRINA (AGNP)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:
Last Name:MOTLEY
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205
Mailing Address - Country:US
Mailing Address - Phone:317-924-4545
Mailing Address - Fax:317-927-2167
Practice Address - Street 1:101 E 34TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205
Practice Address - Country:US
Practice Address - Phone:317-924-4545
Practice Address - Fax:317-924-4545
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28146968A363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care