Provider Demographics
NPI:1932728169
Name:KATSIKAS, AMY LYNN (CNS)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:KATSIKAS
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 FRANK SCOTT PKWY E STE A
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-3979
Mailing Address - Country:US
Mailing Address - Phone:618-558-7888
Mailing Address - Fax:
Practice Address - Street 1:1405 NORTH GREEN MOUNT ROAD
Practice Address - Street 2:SUITE 511
Practice Address - City:O'FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3494
Practice Address - Country:US
Practice Address - Phone:618-558-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016290364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist