Individual
KELCY MARIE CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
363 N WEST ST, OLNEY, IL 62450-1160
(618) 392-9400
Mailing address
2900 ILLINOIS ROUTE 15, ELLERY, IL 62833-4409
(618) 302-3199
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209023657
IL
Other
Enumeration date
08/03/2021
Last updated
08/03/2021
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