Healthcare Provider Details

I. General information

NPI: 1962229195
Provider Name (Legal Business Name): KATELYN RACHELLE BROOKS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 W SOUTH ST
KEWANEE IL
61443-8354
US

IV. Provider business mailing address

302 NATIONAL CT
CAMBRIDGE IL
61238-1431
US

V. Phone/Fax

Practice location:
  • Phone: 309-852-7700
  • Fax:
Mailing address:
  • Phone: 563-499-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number041439014
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: