Individual
KAITLIN COLTHARP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1100 TUSCOLA BLVD, TUSCOLA, IL 61953-2065
(217) 253-4764
(217) 253-4886
Mailing address
PO BOX 372, MATTOON, IL 61938-0372
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-009254
IL
Other
Enumeration date
09/14/2022
Last updated
11/04/2024
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