Individual
KARIE LYNN PROKOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
105 S FIRST ST, WILMINGTON, IL 60481-8973
(815) 476-5210
(815) 476-4193
Mailing address
105 S FIRST ST, WILMINGTON, IL 60481-8973
(815) 476-5210
(815) 476-4193
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.003995
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085.003995
STATE LICENSE
IL
Enumeration date
03/04/2011
Last updated
03/29/2021
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