Healthcare Provider Details

I. General information

NPI: 1366199580
Provider Name (Legal Business Name): KELLE DAWN MONROE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 MAINE ST
QUINCY IL
62301-4096
US

IV. Provider business mailing address

1025 MAINE ST
QUINCY IL
62301-4096
US

V. Phone/Fax

Practice location:
  • Phone: 217-222-6550
  • Fax:
Mailing address:
  • Phone: 217-222-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209024709
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: