Kristyn Marie Radkiewicz, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71008485A Issued in IN

Practice address

105 Water St
Plymouth, IN 46563-2148

Phone

(574) 540-2052

Fax

(574) 540-2540

NPI assigned

Aug 21, 2018

Last updated

Dec 3, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1534809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543795200000",
    "number": "1497235279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 WATER ST",
            "city": "PLYMOUTH",
            "state": "IN",
            "postal_code": "465632148",
            "telephone_number": "574-540-2052",
            "fax_number": "574-540-2540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 WATER ST",
            "city": "PLYMOUTH",
            "state": "IN",
            "postal_code": "465632148",
            "telephone_number": "574-540-2052",
            "fax_number": "574-540-2540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADKIEWICZ",
        "first_name": "KRISTYN",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-21",
        "last_updated": "2018-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71008485A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Plymouth, IN
• Providers in Plymouth, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.