Provider Demographics
NPI:1720694094
Name:MADDEN, KATELYNN (APRN, CNS)
Entity type:Individual
Prefix:
First Name:KATELYNN
Middle Name:
Last Name:MADDEN
Suffix:
Gender:F
Credentials:APRN, CNS
Other - Prefix:
Other - First Name:KATELYNN
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305 E MONROE ST
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:IL
Mailing Address - Zip Code:61548-7115
Mailing Address - Country:US
Mailing Address - Phone:309-696-8183
Mailing Address - Fax:
Practice Address - Street 1:1001 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61606-2035
Practice Address - Country:US
Practice Address - Phone:309-672-5682
Practice Address - Fax:309-672-3147
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022044364SG0600X
IL209.022044364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209022044OtherAPN LICENSE