Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kathryn Mary Wallace, APRN, BC

Individual provider Nurse Practitioner · NPI 1407965320

Kathryn Mary Wallace, APRN, BC is a Nurse Practitioner in Portage, Indiana. Licensed in Indiana. Registered with an NPI since 2006.

Licensed in
IN
In the registry since
2006
What do these letters mean?
APRN — Advanced Practice Registered Nurse
The umbrella licence covering nurse practitioners, midwives, anaesthetists and clinical nurse specialists.
BC — Board Certified
Appended to another credential to show current board certification, as in APRN-BC.

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Practice location Address checks out

2640 Hamstrom Rd
Portage, IN 46368-3832
Phone: (219) 762-4423
Fax: (219) 763-3120
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 71000473A (IN)

Record details

NPI number1407965320
Entity typeIndividual (Type 1)
GenderFemale
Credentials APRN , BC
Sole proprietorNo
NPI enumeratedAugust 30, 2006
Last updated in NPPESSeptember 17, 2012

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