Provider Demographics
NPI:1104891092
Name:KRALL, KATHERINE A (CFNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:KRALL
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62675-9584
Mailing Address - Country:US
Mailing Address - Phone:217-632-7761
Mailing Address - Fax:217-632-0312
Practice Address - Street 1:1 CENTRE DR
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:IL
Practice Address - Zip Code:62675-9584
Practice Address - Country:US
Practice Address - Phone:217-632-7761
Practice Address - Fax:217-632-0312
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209000677363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041-225148OtherRN LICENSE
ILL88799Medicare ID - Type Unspecified
P00151Medicare UPIN