Healthcare Provider Details

I. General information

NPI: 1316628480
Provider Name (Legal Business Name): KALEIGH ANN PETERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PECK SERVICE ROAD
EDWARDSVILLE IL
62026-1506
US

IV. Provider business mailing address

100 CEDAR ST
GREENFIELD IL
62044-1506
US

V. Phone/Fax

Practice location:
  • Phone: 618-650-5688
  • Fax:
Mailing address:
  • Phone: 217-883-7852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2024019208
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: