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General NPI Number Information
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NPI Number | 1215437892
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Entity Type | Individual
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Provider Name | TORY L. KEEFER FNP
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Gender | Female
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Dates
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Enumeration Date | 02/20/2018
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 2512 HURST DR STE 130
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City | MATTOON
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State | IL
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Zip | 61938-9200
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Country | US
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Telephone | 217-258-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 2655 18TH ST
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City | CHARLESTON
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State | IL
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Zip | 61920-4348
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 277.000718
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209017195
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.017195
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License Number State | IL
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