Individual
KATHLEEN GRACE STOCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1745 W WALNUT ST, JACKSONVILLE, IL 62650-6126
(217) 243-6454
(217) 243-1388
Mailing address
1745 W WALNUT ST, JACKSONVILLE, IL 62650-6126
(217) 243-6454
(217) 243-1388
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209000579
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
370661499007
—
IL
Enumeration date
09/06/2006
Last updated
12/17/2021
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