MEDICARE: KATHRYN STEPHENS APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	209034807	IL

General Provider Information

NPI Number	:	1578419222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN STEPHENS APRN

Provider Business Mailing Address
First Line	:	1310 N MISSOURI AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61603-3105
Country	:	US
Telephone Number	:	309-655-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 N MISSOURI AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61603-3105
Country	:	US
Telephone Number	:	309-655-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “ KATHRYN STEPHENS APRN” Practice Location

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