Individual
KELLY J SLADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
176 W MOUND RD, DECATUR, IL 62526-1964
(217) 391-8730
(217) 391-8731
Mailing address
176 W MOUND RD, DECATUR, IL 62526-1964
(217) 391-8730
(217) 391-8731
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209.011917
IL
Other
Enumeration date
10/14/2014
Last updated
11/01/2019
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