Provider Demographics
NPI:1497107296
Name:SWAIN-ABRAHAM, KATHRYN A (APN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:SWAIN-ABRAHAM
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:A
Other - Last Name:SWAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:530 NE GLEN OAK AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61637-0001
Mailing Address - Country:US
Mailing Address - Phone:309-308-0190
Mailing Address - Fax:309-308-0201
Practice Address - Street 1:8600 N STATE ROUTE 91
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-9541
Practice Address - Country:US
Practice Address - Phone:309-683-5050
Practice Address - Fax:309-683-5335
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011103A363LF0000X
IL277001390363LF0000X
IL209-014407363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily