Provider Demographics
NPI:1679755482
Name:JAHN, KATRINA LOU (CNS)
Entity type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:LOU
Last Name:JAHN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:MRS
Other - First Name:KATRINA
Other - Middle Name:LOU
Other - Last Name:NESTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNS
Mailing Address - Street 1:2013 E 65TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2134
Mailing Address - Country:US
Mailing Address - Phone:317-254-0125
Mailing Address - Fax:317-988-2884
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:PSYCHIATRY AMBULATORY CARE CLINIC
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-988-2000
Practice Address - Fax:317-988-2884
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28134167A163W00000X
IN2007009969364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse