Individual
KELSY BRIKAY WASMUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
6810 STATE ROUTE 162 STE 100, MARYVILLE, IL 62062-8560
(618) 288-3616
(618) 288-3647
Mailing address
6810 STATE ROUTE 162 STE 100, MARYVILLE, IL 62062-8560
(618) 288-3616
(618) 288-3647
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209016647
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209016647
LICENSE
IL
Enumeration date
10/10/2017
Last updated
02/24/2020
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