Individual provider Active NPI

Katelynn Crull

  • Family Nurse Practitioner
  • Fort Wayne, IN
National Provider Identifier
1114883386
Registry record updated Jan 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71017639A Issued in IN
Practice address
3512 Stellhorn Rd
Fort Wayne, IN 46815-4631
Phone
(855) 743-2247
NPI assigned
Dec 31, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71017639A IN Primary

Addresses

Primary practice location

3512 Stellhorn Rd
Fort Wayne, IN 46815-4631

Mailing address

PO Box 1431
Dept 400
Charlotte, NC 28201-1431

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260302000877 IN Practitioner - Nurse Practitioner 1355823220 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eventus Ecs, IncGroup PAC ID 2163969650, 243 clinicians
Extended Care Specialists, IncGroup PAC ID 2466407713, 295 clinicians

Practice addresses (Care Compare)

150 W Market St
Suite 400
Indianapolis, IN 46204-2810
Phone (855) 743-2247

8398 Mississippi St
FL 2
Merrillville, IN 46410-6316
Phone (855) 743-2247

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
71017639AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Eventus Ecs, Inc CurrentSince Jan 4, 2026 Accepting new patients
Extended Care Specialists, Inc Family CurrentSince Jan 4, 2026 Accepting new patients

Locations

3512 Stellhorn Rd
Fort Wayne, IN 46815

150 W Market St
Ste 400
Indianapolis, IN 46204

8398 Mississippi St
Fl 2
Merrillville, IN 46410

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1767139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768435200000",
    "number": "1114883386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1431",
            "address_2": "DEPT 400",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282011431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3512 STELLHORN RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468154631",
            "telephone_number": "855-743-2247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRULL",
        "first_name": "KATELYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-12-31",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71017639A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.