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General NPI Number Information
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NPI Number | 1952152043
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Entity Type | Organization
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Legal Business Name | KSKM HEALTH AND WELLNESS
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Dates
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Enumeration Date | 03/28/2024
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 106 E. DAVIS STREET
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City | CATLIN
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State | IL
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Zip | 61817
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Country | US
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Telephone | 217-703-1444
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 80
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City | CATLIN
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State | IL
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Zip | 61817-0080
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Country | US
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Telephone | 217-703-1444
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Fax | 217-703-1515
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MRS. JESSICA GAY
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Credential | FNP-BC, FPA
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Telephone | 217-703-1444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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