Healthcare Provider Details

I. General information

NPI: 1720694094
Provider Name (Legal Business Name): KATELYNN MADDEN APRN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYNN DAVIS

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MAIN ST STE 200
PEORIA IL
61606-2035
US

IV. Provider business mailing address

305 E MONROE ST
METAMORA IL
61548-7115
US

V. Phone/Fax

Practice location:
  • Phone: 309-672-5682
  • Fax: 309-672-3147
Mailing address:
  • Phone: 309-696-8183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number209.022044
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number209022044
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: