Individual provider Active NPI

Katelyn Dykstra, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Munster, IN
National Provider Identifier
1497510689
Registry record updated Apr 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
71015159A Issued in IN
Practice address
901 Macarthur Blvd
Munster, IN 46321-2901
Phone
(219) 392-7466
Fax
(219) 392-7470
NPI assigned
Feb 16, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 71015159A IN Primary

Addresses

Primary practice location

901 Macarthur Blvd
Munster, IN 46321-2901

Mailing address

8558 Broadway
Merrillville, IN 46410-7032
Phone (219) 392-7084

Other practice location 1

1500 S Lake Park Ave
Hobart, IN 46342-6638
Phone (219) 392-7466

Other practice location 2

4320 Fir St Ste 4141
East Chicago, IN 46312-3052
Phone (219) 392-7466

Other practice location 3

10215 Broadway
Crown Point, IN 46307-8001
Phone (219) 392-7466

Other practice location 4

4321 Fir St
East Chicago, IN 46312-3049
Phone (219) 392-7466

Other identifiers 1

IdentifierTypeStateIssuer
300088943MedicaidIN

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
I20240501003376 IN Practitioner - Nurse Practitioner 5597105924 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Care Network IncGroup PAC ID 3678737012, 378 clinicians

Practice addresses (Care Compare)

4321 Fir St
East Chicago, IN 46312-3049
Phone (219) 392-7005

Hospital & facility affiliations

  • Community Hospital Hospital, Munster, IN, CCN 150125
  • St Catherine Hospital Inc Hospital, East Chicago, IN, CCN 150008

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
71015159AINMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Network Inc CurrentSince May 15, 2024 Accepting new patients

Locations

4321 Fir St
East Chicago, IN 46312
Phone (219) 392-1700

4320 Fir St
Ste 4141
East Chicago, IN 46312
Phone (219) 392-7466

1500 S Lake Park Ave
Hobart, IN 46342
Phone (219) 942-0551

8558 Broadway
Merrillville, IN 46410
Phone (219) 392-7084

9130 Columbia Ave
Ste A
Munster, IN 46321
Phone (219) 365-1166

901 MacArthur Blvd
Munster, IN 46321
Phone (219) 703-1443

Organizations & group practices 1

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1708041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714435200000",
    "number": "1497510689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8558 BROADWAY",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464107032",
            "telephone_number": "219-392-7084",
            "fax_number": "219-703-6854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 MACARTHUR BLVD",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212901",
            "telephone_number": "219-392-7466",
            "fax_number": "219-392-7470"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 S Lake Park Ave",
            "address_purpose": "LOCATION",
            "city": "Hobart",
            "state": "IN",
            "postal_code": "463426638",
            "country_code": "US",
            "telephone_number": "219-392-7466",
            "fax_number": "219-392-7470",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4320 Fir St Ste 4141",
            "address_purpose": "LOCATION",
            "city": "East Chicago",
            "state": "IN",
            "postal_code": "463123052",
            "country_code": "US",
            "telephone_number": "219-392-7466",
            "fax_number": "219-392-7470",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10215 Broadway",
            "address_purpose": "LOCATION",
            "city": "Crown Point",
            "state": "IN",
            "postal_code": "463078001",
            "country_code": "US",
            "telephone_number": "219-392-7466",
            "fax_number": "219-392-7470",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4321 Fir St",
            "address_purpose": "LOCATION",
            "city": "East Chicago",
            "state": "IN",
            "postal_code": "463123049",
            "country_code": "US",
            "telephone_number": "219-392-7466",
            "fax_number": "219-392-7470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DYKSTRA",
        "first_name": "KATELYN",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-16",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71015159A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300088943",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Munster, IN

Sources for this page

Verify at the official NPI Registry.