Provider Demographics
NPI:1174018592
Name:THURMAN, KATELYN GRACE (APRN)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:GRACE
Last Name:THURMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1674 E US HIGHWAY 136
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:IL
Mailing Address - Zip Code:62321-3530
Mailing Address - Country:US
Mailing Address - Phone:217-242-3596
Mailing Address - Fax:
Practice Address - Street 1:1603 MORGAN ST
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-3430
Practice Address - Country:US
Practice Address - Phone:319-524-6274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA150682363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily