Provider Demographics
NPI:1487010955
Name:POYSER, KATHI ANN (BSN, RN)
Entity Type:Individual
Prefix:
First Name:KATHI
Middle Name:ANN
Last Name:POYSER
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 KENTUCKY RD E
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4477
Mailing Address - Country:US
Mailing Address - Phone:217-577-3069
Mailing Address - Fax:
Practice Address - Street 1:416 KENTUCKY RD E
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4477
Practice Address - Country:US
Practice Address - Phone:217-577-3069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.363140163W00000X
NMRN-76160163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMRN-76160OtherLICENSE
IL041.363140OtherLICENSE