Healthcare Provider Details

I. General information

NPI: 1225461668
Provider Name (Legal Business Name): KAITLYN J STROH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2861 MADISON AVE
GRANITE CITY IL
62040-3614
US

IV. Provider business mailing address

2861 MADISON AVE
GRANITE CITY IL
62040-3614
US

V. Phone/Fax

Practice location:
  • Phone: 618-709-7723
  • Fax:
Mailing address:
  • Phone: 618-709-7723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2018022299
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number041520632
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2024019631
License Number StateMO
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.030146
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: