Individual
KELLY ANDREA MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-C
Contact information
Practice address
50 NORTHGATE INDUSTRIAL DR, GRANITE CITY, IL 62040-6805
(618) 877-4420
Mailing address
1632 OLD FOSTERBURG RD, ALTON, IL 62002-8840
(618) 616-3672
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
041273311
IL
363LF0000X
Family Nurse Practitioner
377.003351
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041273311
REGISTERED NURSE
IL
Enumeration date
08/13/2008
Last updated
10/30/2024
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