Healthcare Provider Details

I. General information

NPI: 1679075022
Provider Name (Legal Business Name): KYLE MAY APRN, CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 EASTLAND DR STE 320
BLOOMINGTON IL
61701-7912
US

IV. Provider business mailing address

1505 EASTLAND DR STE 320
BLOOMINGTON IL
61701-7912
US

V. Phone/Fax

Practice location:
  • Phone: 309-661-2368
  • Fax: 309-662-9709
Mailing address:
  • Phone: 309-661-2368
  • Fax: 309-662-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number209.017287
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209017287
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: