Provider Demographics
NPI:1740615145
Name:HAMBLEN, KATHRYN JOAN (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:JOAN
Last Name:HAMBLEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:JOAN
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:579 E 6000S RD
Mailing Address - Street 2:
Mailing Address - City:CHEBANSE
Mailing Address - State:IL
Mailing Address - Zip Code:60922-5069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:579 E 6000S RD
Practice Address - Street 2:
Practice Address - City:CHEBANSE
Practice Address - State:IL
Practice Address - Zip Code:60922-5069
Practice Address - Country:US
Practice Address - Phone:815-867-2561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-191879363LF0000X
ID71325363LF0000X
FL11021212363LF0000X
INTS0001571363LF0000X
IL277001634363LF0000X
NC5018952363L00000X
IL209010678363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner