Healthcare Provider Details

I. General information

NPI: 1043376650
Provider Name (Legal Business Name): KATHERINE COLLINS-WHITTAKER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE COLLINS CNP

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 LANDMARKS BLVD
ALTON IL
62002-6321
US

IV. Provider business mailing address

550 LANDMARKS BLVD
ALTON IL
62002-6321
US

V. Phone/Fax

Practice location:
  • Phone: 618-463-5905
  • Fax: 618-463-5935
Mailing address:
  • Phone: 618-463-5905
  • Fax: 618-463-5935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number067298
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209002894
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209002894
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number067298
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209002894
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041287817
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number067298
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: