Healthcare Provider Details

I. General information

NPI: 1043901697
Provider Name (Legal Business Name): KALEIGH C KUHLMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 BROADWAY ST
QUINCY IL
62301-3713
US

IV. Provider business mailing address

3301 BROADWAY ST
QUINCY IL
62301-3713
US

V. Phone/Fax

Practice location:
  • Phone: 217-222-6220
  • Fax:
Mailing address:
  • Phone: 217-222-6220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209029807
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2018019177
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2023027183
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: