KRISTIN MARIE WYMER N.P. NPI 1679058762

NPI Information

NPI: 1679058762
Provider Name: KRISTIN MARIE WYMER, N.P.
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
100 NAVARRE PL STE 5500
SOUTH BEND, IN
ZIP 46601
Phone: (574) 647-5300
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Kristin Marie Wymer, N.P. is a family nurse practitioner in South Bend, IN. Kristin Marie Wymer, N.P. NPI is 1679058762. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

100 NAVARRE PL STE 5500
SOUTH BEND, IN
ZIP 46601-172
Phone: (574) 647-5300

The NPI 1679058762 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/25/2018 and was last updated on 4/19/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	163WR0006X	Registered Nurse	Registered Nurse First Assistant	28193580A	INDIANA	No
2	363LF0000X	Nurse Practitioner	Family	71008462A	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	169380084	OTHER	INDIANA	MEDICARE PTAN
2	247000032	OTHER	INDIANA	MEDICARE PTAN
3	261970104	OTHER	INDIANA	MEDICARE PTAN
4	300020098	MEDICAID	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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