Individual provider Active NPI

Katelyn R Russell, PMHNP-BC

  • Nurse Practitioner
  • Evansville, IN
National Provider Identifier
1619732633
Registry record updated Apr 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
28196825A Issued in IN
Practice address
7200 E Indiana St
Evansville, IN 47715-2753
Phone
(812) 476-7200
Fax
(812) 471-4514
NPI assigned
Feb 19, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 28196825A IN Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 71014906A IN

Addresses

Primary practice location

7200 E Indiana St
Evansville, IN 47715-2753

Mailing address

PO Box 632281
Cincinnati, OH 45263-2281
Phone (812) 450-6822

Other practice location 1

445 N Cross Pointe Blvd
Evansville, IN 47715-4010
Phone (812) 471-4611

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
I20240612002537 IN Practitioner - Nurse Practitioner 0143762542 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Deaconess Hospital, Inc.Group PAC ID 9032021431, 410 clinicians

Practice addresses (Care Compare)

7200 E Indiana St
Evansville, IN 47715-2753
Phone (812) 476-7200

Hospital & facility affiliations

  • Deaconess Hospital Inc Hospital, Evansville, IN, CCN 150082

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
28196825AINMDNurse Practitioner
71014906AINMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Hospital Inc Nurse Practitioner CurrentSince May 6, 2024 Accepting new patients
Deaconess Hospital, Inc Nurse Practitioner CurrentSince May 6, 2024 Accepting new patients
Deaconess Hospital, Inc Nurse Practitioner Current Accepting new patients

Locations

7200 E Indiana St
Evansville, IN 47715
Phone (812) 476-7200

445 N Cross Pointe Blvd
Evansville, IN 47715
Phone (812) 402-2003

Interoperability endpoints

  • Direct secure messaging: krussell45208@direct.deaconess.com

Organizations & group practices 3

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": "1708300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775088000000",
    "number": "1619732633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 632281",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452632281",
            "telephone_number": "812-450-6822",
            "fax_number": "812-450-6815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7200 E INDIANA ST",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477152753",
            "telephone_number": "812-476-7200",
            "fax_number": "812-471-4514"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "445 N Cross Pointe Blvd",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477154010",
            "country_code": "US",
            "telephone_number": "812-471-4611",
            "fax_number": "812-471-4514",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "KATELYN",
        "middle_name": "R",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-19",
        "last_updated": "2026-04-02",
        "certification_date": "2026-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "28196825A",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71014906A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.