Provider Demographics
NPI:1306861463
Name:KINSELLA, KATHERINE (RN, FNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:KINSELLA
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:KEWANEE
Mailing Address - State:IL
Mailing Address - Zip Code:61443-0747
Mailing Address - Country:US
Mailing Address - Phone:309-852-7700
Mailing Address - Fax:309-852-7764
Practice Address - Street 1:1051 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:KEWANEE
Practice Address - State:IL
Practice Address - Zip Code:61443-8354
Practice Address - Country:US
Practice Address - Phone:309-852-7700
Practice Address - Fax:309-852-7764
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL309-000755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3715468OtherBLUE CROSS BLUE SHIELD
IL371548OtherBC/BS
IL210945Medicare ID - Type Unspecified
IL143445Medicare Oscar/Certification
IL3715468OtherBLUE CROSS BLUE SHIELD