Individual
KELLY KNACKSTEDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1285 FRANCISCAN DR, LITCHFIELD, IL 62056-1778
(217) 324-6127
(217) 324-9293
Mailing address
PO BOX 27, ALHAMBRA, IL 62001-0027
(618) 488-2694
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.407486
IL
163W00000X
Registered Nurse
2012036019
MO
363LF0000X
Family Nurse Practitioner
Primary
209019036
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209.019036
—
IL
Enumeration date
07/16/2015
Last updated
07/22/2019
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