Healthcare Provider Details

I. General information

NPI: 1760316756
Provider Name (Legal Business Name): KAYLA MARIE BUSKIRK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9014 N WOOD SAGE RD
PEORIA IL
61615-7908
US

IV. Provider business mailing address

126 W MCCLURE AVE
BARTONVILLE IL
61607-2453
US

V. Phone/Fax

Practice location:
  • Phone: 844-360-8600
  • Fax:
Mailing address:
  • Phone: 309-229-7024
  • Fax: 309-229-7024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209034382
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: