Provider Demographics
NPI:1861965873
Name:CARNES, KATHRYN E (APN)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:CARNES
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:E
Other - Last Name:CARNES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:PO BOX 3428
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62708-3428
Mailing Address - Country:US
Mailing Address - Phone:217-588-2624
Mailing Address - Fax:217-757-2021
Practice Address - Street 1:3132 OLD JACKSONVILLE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-7400
Practice Address - Country:US
Practice Address - Phone:217-588-2600
Practice Address - Fax:217-862-0904
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041384491OtherRN LICENSE