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General NPI Number Information
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NPI Number | 1629734264
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Entity Type | Individual
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Provider Name | KELLI R BEAN APRN, FPA, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/09/2021
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Last Update Date | 01/25/2025
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Provider Practice Location Address
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Address Line | 105 S MAIN ST
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City | PINCKNEYVILLE
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State | IL
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Zip | 62274-1458
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Country | US
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Telephone | 618-995-8073
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Fax | 618-822-4019
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Provider Business Mailing Address
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Address Line | PO BOX 7
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City | DU QUOIN
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State | IL
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Zip | 62832-0007
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Country | US
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Telephone | 618-995-8073
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Fax | 618-228-4019
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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 | 209024317
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 277003403
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License Number State | IL
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