Healthcare Provider Details

I. General information

NPI: 1013845122
Provider Name (Legal Business Name): KILEY BUGAIESKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NE GLEN OAK AVE
PEORIA IL
61637-0001
US

IV. Provider business mailing address

441 S MONTANA AVE
MORTON IL
61550-2731
US

V. Phone/Fax

Practice location:
  • Phone: 309-665-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number041461698
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: