Individual
KIMBERLY ANNE OGLESBY MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-BC
Contact information
Practice address
701 N 1ST ST, SPRINGFIELD, IL 62781-1069
(217) 788-3000
Mailing address
605 N MARION ST, MOUNT PULASKI, IL 62548-1069
(217) 971-4101
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209.014904
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041.386754
RN LICENSE
IL
Enumeration date
09/22/2016
Last updated
03/25/2020
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