Provider Demographics
NPI:1285250712
Name:MCGOUGH, KAITLYN S (APRN, CNP)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:S
Last Name:MCGOUGH
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:S
Other - Last Name:HINZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:834 N SEMINARY ST STE 302402
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-2852
Mailing Address - Country:US
Mailing Address - Phone:309-343-5114
Mailing Address - Fax:
Practice Address - Street 1:834 N SEMINARY ST STE 302402
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2852
Practice Address - Country:US
Practice Address - Phone:309-343-5114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-20
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023431363LF0000X
IL277004321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily