Individual
MRS. FELICIA DESHA KIMBROUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP BC
Contact information
Practice address
1301 E WALNUT ST RM J120, CARBONDALE, IL 62901-5004
(618) 519-9200
(618) 457-8931
Mailing address
109 CALIFORNIA ST, CARTERVILLE, IL 62918-1923
(618) 985-8221
(618) 985-6860
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209007991
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
370966854002
—
IL
05
—
370966854005
—
IL
05
—
406333266001
—
IL
01
—
CF3444
MEDICARE RR
IL
Enumeration date
05/08/2008
Last updated
08/16/2022
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