Stark, Kathy Jean

Stark, Kathy Jean is an individual health care provider with primary practice located at 747 N Rutledge St 5Th Floor, Springfield IL 62702-6700. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Gerontology, Physician Assistants & Advanced Practice Nursing Providers / Adult Health. Physician Assistants & Advanced Practice Nursing Providers / Gerontology is her primary health care specialty. Stark, Kathy Jean can be contacted via phone (217) 545-8000.

Contact Information

Primary practice address
747 N Rutledge St 5Th Floor Springfield IL 62702-6700
Phone: (217) 545-8000
Fax: (217) 545-7063
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X 209014267 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 209014267 Illinois

Profile Details

NPI number 1457704025
LBN Legal business name Stark, Kathy Jean
Credentials AGPCNP-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2016
Last updated Dec 7th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457704025 NPPES
Illinois MEDICAID 209014267

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