Individual
KELLIE BIBB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3220 ATLANTA ST, SPRINGFIELD, IL 62707-8801
(217) 588-2600
(217) 862-0202
Mailing address
PO BOX 3428, SPRINGFIELD, IL 62708-3428
(217) 588-2600
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
209013401
IL
363LF0000X
Family Nurse Practitioner
Primary
277.000110
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041.382679
RN
IL
Enumeration date
10/22/2015
Last updated
07/19/2022
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