Healthcare Provider Details

I. General information

NPI: 1265348635
Provider Name (Legal Business Name): KAITLYN NORMAN RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 FORTUNE BLVD
SHILOH IL
62269-7358
US

IV. Provider business mailing address

7 JULIA DR
BREESE IL
62230-2084
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-5266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.490523
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: