Healthcare Provider Details

I. General information

NPI: 1346684248
Provider Name (Legal Business Name): TIFFANY L KUHLMEYER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 HIGHLAND VIEW DR
FREEPORT IL
61032-6942
US

IV. Provider business mailing address

PO BOX 268
FREEPORT IL
61032-0268
US

V. Phone/Fax

Practice location:
  • Phone: 815-235-3165
  • Fax: 815-235-7903
Mailing address:
  • Phone: 815-599-7950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number041366147
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: