Individual
KATHY JEAN STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP-BC
Contact information
Practice address
747 N RUTLEDGE ST, 5TH FLOOR, SPRINGFIELD, IL 62702-6700
(217) 545-8000
(217) 545-7063
Mailing address
747 N RUTLEDGE ST, PO BOX 19627, SPRINGFIELD, IL 62702-6700
(217) 545-8000
(217) 545-7063
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
209014267
IL
363LG0600X
Gerontology Nurse Practitioner
Primary
209014267
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209014267
—
IL
Enumeration date
07/19/2016
Last updated
12/07/2020
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