Provider Demographics
NPI:1700962867
Name:VOELKER, KATHLEEN L (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:L
Last Name:VOELKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3089
Mailing Address - Country:US
Mailing Address - Phone:309-655-7900
Mailing Address - Fax:309-655-7903
Practice Address - Street 1:200 E PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3089
Practice Address - Country:US
Practice Address - Phone:309-655-7900
Practice Address - Fax:309-655-7903
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041200279/209005676363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK22074Medicare ID - Type UnspecifiedINDIVIDUAL #
Q55103Medicare UPIN
IL207594Medicare ID - Type UnspecifiedGROUP #
ILP00267721 / CA4079Medicare ID - Type UnspecifiedRR