Healthcare Provider Details

I. General information

NPI: 1922924034
Provider Name (Legal Business Name): KRISTIN BRUST CFNC, BCHHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 STEARN DR
GENOA IL
60135-1456
US

IV. Provider business mailing address

611 STEARN DR
GENOA IL
60135-1456
US

V. Phone/Fax

Practice location:
  • Phone: 815-351-9241
  • Fax:
Mailing address:
  • Phone: 815-351-9241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number2023673858
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: