Provider Demographics
NPI:1790155836
Name:KASPER, KATIE (NP-C)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:KASPER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 N KINZIE AVE
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-1233
Mailing Address - Country:US
Mailing Address - Phone:815-933-2589
Mailing Address - Fax:815-634-5253
Practice Address - Street 1:990 N KINZIE AVE
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915
Practice Address - Country:US
Practice Address - Phone:815-933-2589
Practice Address - Fax:815-634-5253
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013382363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily