Individual
KATHERINE BLOODWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MNP
Contact information
Practice address
1501 MCPHERSON AVE, MOUNT VERNON, IL 62864-2831
(618) 241-1748
Mailing address
1501 MCPHERSON AVE, MOUNT VERNON, IL 62864-2831
(618) 241-1748
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209005931
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG2264
RR MED GRP ID
IL
01
—
P00635208
RR MEDICARE ID
IL
Enumeration date
10/03/2006
Last updated
11/26/2008
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