Healthcare Provider Details

I. General information

NPI: 1255754529
Provider Name (Legal Business Name): KI RISTIA J ALLEN-LAMPE FNP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4941 BENCHMARK CENTRE DR STE 200
SWANSEA IL
62226-2038
US

IV. Provider business mailing address

21580 BIRG ST
CARLYLE IL
62231-6471
US

V. Phone/Fax

Practice location:
  • Phone: 618-972-1568
  • Fax: 618-205-3561
Mailing address:
  • Phone: 618-322-7217
  • Fax: 618-227-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277002964
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277002964
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: