Healthcare Provider Details

I. General information

NPI: 1649856717
Provider Name (Legal Business Name): KMISHA BRAND RN, MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 09/11/2025
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 SPINDER DR STE 4015
EAST PEORIA IL
61611
US

IV. Provider business mailing address

133 SPINDER DR STE 4015
EAST PEORIA IL
61611
US

V. Phone/Fax

Practice location:
  • Phone: 309-308-5100
  • Fax:
Mailing address:
  • Phone: 309-308-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.020594
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: