Individual
KAITLYN TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
800 N 1ST ST, SPRINGFIELD, IL 62702-3778
(217) 528-7541
Mailing address
PO BOX 19248, SPRINGFIELD, IL 62794-9248
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209.020167
IL
Other
Enumeration date
11/18/2019
Last updated
10/06/2023
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