Individual
KELLY DESMARAIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
719 N WILLIAM KUMPF BLVD STE 100, PEORIA, IL 61605-2531
(309) 624-9934
Mailing address
15776 HERBERGER RD, MACKINAW, IL 61755-9221
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209.032862
IL
Other
Enumeration date
07/31/2025
Last updated
07/31/2025
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