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General NPI Number Information
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NPI Number | 1619442555
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Entity Type | Individual
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Provider Name | MALINDA KEMPER FNP
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Gender | Female
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Dates
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Enumeration Date | 10/08/2018
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 2133 VADALABENE DR STE 5B
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City | MARYVILLE
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State | IL
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Zip | 62062-5839
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Country | US
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Telephone | 618-288-7605
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Fax | 618-615-4204
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Provider Business Mailing Address
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Address Line | 1203 W CARPENTER ST
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City | JERSEYVILLE
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State | IL
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Zip | 62052-1374
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Country | US
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Telephone | 618-946-9489
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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 | 209018336
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License Number State | IL
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