Healthcare Provider Details

I. General information

NPI: 1386588283
Provider Name (Legal Business Name): KATHERINE BARBARA CLEMMONS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 TIMBER TRAILS BLVD
GILBERTS IL
60136-4055
US

IV. Provider business mailing address

224 TIMBER TRAILS BLVD
GILBERTS IL
60136-4055
US

V. Phone/Fax

Practice location:
  • Phone: 847-927-0834
  • Fax:
Mailing address:
  • Phone: 847-927-0834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number041.378602
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: