Healthcare Provider Details

I. General information

NPI: 1104891092
Provider Name (Legal Business Name): KATHERINE A KRALL CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CENTRE DR
PETERSBURG IL
62675-9584
US

IV. Provider business mailing address

1 CENTRE DR
PETERSBURG IL
62675-9584
US

V. Phone/Fax

Practice location:
  • Phone: 217-632-7761
  • Fax: 217-632-0312
Mailing address:
  • Phone: 217-632-7761
  • Fax: 217-632-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209000677
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: