Individual
KERI DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1054 M. L. KING DRIVE #125, CENTRAILIA, IL 62801
(618) 436-5200
Mailing address
197 WESTMORE DRIVE, AVISTON, IL 62216
(618) 560-8797
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209.012941
IL
Other
Enumeration date
07/24/2015
Last updated
07/24/2015
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