Provider Demographics
NPI:1366559148
Name:DOTY, KARLYN (NP)
Entity type:Individual
Prefix:MRS
First Name:KARLYN
Middle Name:
Last Name:DOTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KARLYN
Other - Middle Name:
Other - Last Name:KINKADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 N JORDAN AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47405-3190
Mailing Address - Country:US
Mailing Address - Phone:812-855-4144
Mailing Address - Fax:812-855-4868
Practice Address - Street 1:600 N JORDAN AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47405-3190
Practice Address - Country:US
Practice Address - Phone:812-855-4144
Practice Address - Fax:812-855-4868
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001492A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily