Provider Demographics
NPI:1871368134
Name:YOUR CORNER PEDIATRICS, LLC
Entity type:Organization
Organization Name:YOUR CORNER PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:317-676-9943
Mailing Address - Street 1:819 E 64TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1657
Mailing Address - Country:US
Mailing Address - Phone:317-676-9943
Mailing Address - Fax:317-943-9892
Practice Address - Street 1:819 E 64TH ST STE 103
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1657
Practice Address - Country:US
Practice Address - Phone:317-676-9943
Practice Address - Fax:317-943-9892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1265662076OtherNPI NUMBER
IN1659923761OtherNPI NUMBER