Provider Demographics
NPI:1508228818
Name:SINCLAIR, KATELYN N (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:N
Last Name:SINCLAIR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:N
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:390 MAPLE SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-2000
Mailing Address - Country:US
Mailing Address - Phone:618-498-7518
Mailing Address - Fax:618-498-3052
Practice Address - Street 1:903 S STATE ST
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-2344
Practice Address - Country:US
Practice Address - Phone:618-639-9255
Practice Address - Fax:618-639-8100
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209014112OtherIL APN