Individual
KELSI EARL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
3220 ATLANTA ST, SPRINGFIELD, IL 62707-8801
(217) 588-7400
(217) 588-7439
Mailing address
3220 ATLANTA ST, SPRINGFIELD, IL 62707-8801
(217) 588-7400
(217) 588-7439
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.414192
IL
363LF0000X
Family Nurse Practitioner
Primary
209.019718
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041.414192
RN LICENSE
IL
Enumeration date
07/15/2019
Last updated
09/19/2019
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