Individual
KELI STEWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
800 SCHOOL ST, CARROLLTON, IL 62016-1436
(217) 942-6946
Mailing address
800 SCHOOL ST, CARROLLTON, IL 62016-1436
(217) 942-6946
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209011903
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209011903
STATE OF IL LICENSE
IL
Enumeration date
09/24/2014
Last updated
02/06/2023
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