Individual
KYLE RYAN FARIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ACNPC-AG
Contact information
Practice address
1001 MAIN ST STE 200, PEORIA, IL 61606-2035
(309) 672-5682
(309) 672-3147
Mailing address
10210 NE 189TH ST UNIT A, BOTHELL, WA 98011-3836
(760) 217-8584
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
209032698
IL
Other
Enumeration date
11/23/2024
Last updated
07/12/2025
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