Individual
KELLY MARIE WEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
250 W KENWOOD AVE, DECATUR, IL 62526-4371
(217) 528-7541
(217) 233-6574
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2499
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209014918
IL
Other
Enumeration date
09/28/2016
Last updated
05/19/2020
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