Healthcare Provider Details

I. General information

NPI: 1073310900
Provider Name (Legal Business Name): KRISTY JO ELDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 CLOVER CT
GIBSON CITY IL
60936-1902
US

IV. Provider business mailing address

509 CLOVER CT
GIBSON CITY IL
60936-1902
US

V. Phone/Fax

Practice location:
  • Phone: 217-778-4372
  • Fax:
Mailing address:
  • Phone: 217-778-4372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number041361150
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: