Healthcare Provider Details

I. General information

NPI: 1316896327
Provider Name (Legal Business Name): KATHRYN HOUBOLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10929 S KENTON AVE
OAK LAWN IL
60453-5609
US

IV. Provider business mailing address

10929 S KENTON AVE
OAK LAWN IL
60453-5609
US

V. Phone/Fax

Practice location:
  • Phone: 708-860-5283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAG11250049
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: