Provider Demographics
NPI:1659805513
Name:HOUSE, KATHERINE E (FNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:HOUSE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:916 TALON DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1848
Mailing Address - Country:US
Mailing Address - Phone:618-628-8211
Mailing Address - Fax:618-628-0883
Practice Address - Street 1:12 WOLF CREEK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2314
Practice Address - Country:US
Practice Address - Phone:618-239-9910
Practice Address - Fax:618-628-0883
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209015689363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily