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General NPI Number Information
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NPI Number | 1841027083
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Entity Type | Individual
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Provider Name | KELLY CHRISTINE PUENT APN
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Gender | Female
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Dates
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Enumeration Date | 09/19/2024
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 1001 MAIN ST
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City | PEORIA
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State | IL
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Zip | 61606-1907
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Country | US
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Telephone | 309-672-5522
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Fax |
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Provider Business Mailing Address
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Address Line | 705 CRESTVIEW DR
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City | WASHINGTON
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State | IL
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Zip | 61571-1604
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Country | US
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Telephone | 309-713-6702
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 209-030609
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 209-030609
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License Number State | IL
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