Healthcare Provider Details

I. General information

NPI: 1134751332
Provider Name (Legal Business Name): KATELYNNE GRACE SITTON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 SUSAN DR STE C
NORMAL IL
61761-6285
US

IV. Provider business mailing address

321 SUSAN DR STE C
NORMAL IL
61761-6285
US

V. Phone/Fax

Practice location:
  • Phone: 309-455-5703
  • Fax: 309-204-5456
Mailing address:
  • Phone: 309-455-5703
  • Fax: 309-204-5456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.434937
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277.005264
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: