Healthcare Provider Details

I. General information

NPI: 1487529368
Provider Name (Legal Business Name): KYLE MUSKA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N MAPLE ST
EFFINGHAM IL
62401-2006
US

IV. Provider business mailing address

201 W JOURDAN ST
NEWTON IL
62448-9996
US

V. Phone/Fax

Practice location:
  • Phone: 217-342-2121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number041497388
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: