Provider Demographics
NPI:1609343128
Name:NORTHCUTT, KATY JO (APN, FNP-BC, ENP-C)
Entity type:Individual
Prefix:MS
First Name:KATY
Middle Name:JO
Last Name:NORTHCUTT
Suffix:
Gender:F
Credentials:APN, FNP-BC, ENP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HEARTLAND DR STE C
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-7733
Mailing Address - Country:US
Mailing Address - Phone:309-663-7642
Mailing Address - Fax:309-663-8359
Practice Address - Street 1:9 HEARTLAND DR STE C
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-7733
Practice Address - Country:US
Practice Address - Phone:309-663-7642
Practice Address - Fax:309-663-8359
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.018225363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily