Healthcare Provider Details

I. General information

NPI: 1801515812
Provider Name (Legal Business Name): KATIE CHILES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E COLLEGE AVE
BLOOMINGTON IL
61704-2100
US

IV. Provider business mailing address

1701 E COLLEGE AVE
BLOOMINGTON IL
61704-2100
US

V. Phone/Fax

Practice location:
  • Phone: 309-664-3120
  • Fax:
Mailing address:
  • Phone: 309-664-3120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.025449
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: