Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mrs. Kathleen Vanderreyden, NP

Individual provider Nurse Practitioner · NPI 1225668312

Mrs. Kathleen Vanderreyden, NP is a Nurse Practitioner in Fort Wayne, Indiana. Qualified in 2019, 7 years ago. Practices with Legacy Treatment Center LLC, a 2-clinician group and accepts Medicare assignment. Licensed in Indiana.

Years since qualifying
7
Licensed in
IN
In the registry since
2020
What do these letters mean?
NP — Nurse Practitioner
An advanced practice nurse who can diagnose, treat and in most states prescribe.

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Practice location Address checks out

3030 Lake Ave Ste 24
Fort Wayne, IN 46805-5428
Phone: (260) 201-3119
Fax: (260) 233-7416
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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 71009667A (IN)

Record details

NPI number1225668312
Entity typeIndividual (Type 1)
GenderFemale
Credentials NP
Sole proprietorNo
NPI enumeratedJanuary 17, 2020
Last updated in NPPESJuly 6, 2026
Certification dateJuly 6, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Legacy Treatment Center Llc — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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