Provider Demographics
NPI:1346043767
Name:AMANN, KATELYN MARILYN (WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:MARILYN
Last Name:AMANN
Suffix:
Gender:
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1597
Mailing Address - Country:US
Mailing Address - Phone:217-549-6678
Mailing Address - Fax:
Practice Address - Street 1:4901 FOREST PARK AVE STE 341
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1453
Practice Address - Country:US
Practice Address - Phone:314-454-7882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025011516363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health