Individual
MS. KATHLEEN W. SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
900 MAIN STREET SUITE 280, PEORIA, IL 61636-4688
(309) 643-6118
(309) 517-7476
Mailing address
10611 N SLEEPY HOLLOW RD, PEORIA, IL 61615-1121
(309) 712-1363
(309) 517-7476
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209.012013
IL
364SA2200X
Adult Health Clinical Nurse Specialist
Primary
209012013
IL
Other
Enumeration date
10/22/2014
Last updated
07/25/2024
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