Doctor Name: | KIM A EARL |
NPI Number: | 1063669497 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC |
License Number: | 209007155 |
Business Practice Address: | 600 N Main St Taylorville, IL - 625681668 |
Business Phone Number: | 2172878855 |
Business Fax Number: | |
Mailing Address: | 1025 S 6th St, SPRINGFIELD |
State: | IL |
Postal Code: | 627032403 |
Phone Number: | 2175287541 |
Fax Number: | |
NPI Enumeration Date: | 08/27/2008 |
NPI Last Update Date: | 08/10/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209007155 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |