Healthcare Provider Details

I. General information

NPI: 1609211804
Provider Name (Legal Business Name): KATE LYNN HORSTMEYER RD LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 S CONGRESS ST
RUSHVILLE IL
62681-1465
US

IV. Provider business mailing address

1517 PRAIRIE VISTA DR
CHATHAM IL
62629-5095
US

V. Phone/Fax

Practice location:
  • Phone: 217-322-4321
  • Fax:
Mailing address:
  • Phone: 812-204-8110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT82723
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164005179
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: