Individual
MRS. KILEY M FAIRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
4600 MEMORIAL DRIVE STE 360, BELLEVILLE, IL 62226
(618) 222-7280
(618) 222-7281
Mailing address
4600 MEMORIAL DRIVE STE 360, BELLEVILLE, IL 62226
(618) 222-7280
(618) 222-7281
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209014128
IL
Other
Enumeration date
04/11/2016
Last updated
02/04/2021
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