Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 71008500A | IN |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 9329 | CT |
NPI | 1033693213 |
---|---|
Provider Name | Katie Marie Feeney |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Mansfield Center, CT 06250-1683 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2018 |
Last Update Date | 22/01/2021 |