Kathryn F McKenna, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209021685 Issued in IL

Practice address

5213 Godfrey Rd Ste 110
Godfrey, IL 62035-2510

Phone

(618) 619-3330

NPI assigned

Aug 3, 2020

Last updated

Jan 3, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fairview Heights Medical Group SCGroup PAC ID 6800784083, 448 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fairview Heights Medical Group SC

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1679503668

  IL

  Medicare reassignment Care Compare group NPD
• Alton Urgent Care Walk in Clinic Company

  • Family Medicine Physician
  • Alton, IL
  • NPI 1013521343
  Medicare reassignment NPD
• Belleville Urgent Care Walk-in Clinic

  • Family Medicine Physician
  • Belleville, IL
  • NPI 1225694946
  Medicare reassignment NPD
• Emergency Services Midwest SC

  • Emergency Medicine Physician
  • Belleville, IL
  • NPI 1174024806

  Nurse Practitioner

  Medicare reassignment NPD
• Granite City Urgent Care Walk-in Clinic

  • Urgent Care Clinic/Center
  • Granite City, IL
  • NPI 1659861953
  Medicare reassignment NPD
• Waterloo Urgent Care Walk in Clinic Company

  • Family Medicine Physician
  • Waterloo, IL
  • NPI 1508471418
  Medicare reassignment NPD
• Wood River Urgent Care and Walk in Clinic Inc

  • Family Medicine Physician
  • Wood River, IL
  • NPI 1427717438

  Nurse Practitioner

  Medicare reassignment NPD
• Southeastern Emergency Services of Memphis, P.C.

  • Emergency Medicine Physician
  • Chattanooga, TN
  • NPI 1164454450

  IL, Nurse Practitioner

  Medicare reassignment NPD
• Fairview Heights Medical Group SC

  dba BJC Medical Group of Illinois

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1073022000
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1596412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735862400000",
    "number": "1902416134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5213 GODFREY RD STE 110",
            "city": "GODFREY",
            "state": "IL",
            "postal_code": "620352510",
            "telephone_number": "618-619-3330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5213 GODFREY RD STE 110",
            "city": "GODFREY",
            "state": "IL",
            "postal_code": "620352510",
            "telephone_number": "618-619-3330"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 E High St",
            "address_purpose": "LOCATION",
            "city": "Morrison",
            "state": "IL",
            "postal_code": "612702813",
            "country_code": "US",
            "telephone_number": "815-499-9775",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKENNA",
        "first_name": "KATHRYN",
        "middle_name": "F",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-03",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209021685",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.021685",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "400 E High St",
            "city": "Morrison",
            "state": "IL",
            "country_code": "US",
            "postal_code": "612702813",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Emily Suzanne Martin, D.M.D.
• Norman Petronio Martinez Sr., DDS
• Bradley D Martinson, OD
• James Mathus, D.M.D.
• Neill McDonald, LPTA
• Melanie Means
• Katie Ann Medford, PHARMD
• James Edward Merkle, D.M.D.
• Melissa Merkle, COTA
• Michael Robert Messmer, D.O.

• Nurse Practitioner in Godfrey, IL
• Providers in Godfrey, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.