Healthcare Provider Details

I. General information

NPI: 1760965768
Provider Name (Legal Business Name): KARA M LITTLEJOHN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LUDWIG DR
FAIRVIEW HEIGHTS IL
62208-1332
US

IV. Provider business mailing address

3404 CASTLE PINES CT
SWANSEA IL
62226-1194
US

V. Phone/Fax

Practice location:
  • Phone: 618-397-9000
  • Fax:
Mailing address:
  • Phone: 618-830-4639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209032702
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160-004457
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: