KATHY JEAN STARK AGPCNP-BC NPI 1457704025

NPI Information

NPI: 1457704025
Provider Name: KATHY JEAN STARK, AGPCNP-BC
Classification: Nurse Practitioner - 363LG0600X
Entity Type: Individual

Specialization: Gerontology

PECOS Registration: Yes

Address:
747 N RUTLEDGE ST
5TH FLOOR
SPRINGFIELD, IL
ZIP 62702
Phone: (217) 545-8000
Get Directions

Kathy Jean Stark, AGPCNP-BC is a gerontology nurse practitioner in Springfield, IL. Kathy Jean Stark, AGPCNP-BC NPI is 1457704025. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

747 N RUTLEDGE ST
5TH FLOOR
SPRINGFIELD, IL
ZIP 62702-700
Phone: (217) 545-8000
Fax: (217) 545-7063

The NPI 1457704025 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/19/2016 and was last updated on 12/7/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LG0600X	Nurse Practitioner	Gerontology	209014267	ILLINOIS	Yes
2	363LA2200X	Nurse Practitioner	Adult Health	209014267	ILLINOIS	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	209014267	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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