KELSY BRIKAY WASMUTH FNP NPI 1336659838

NPI Information

NPI: 1336659838
Provider Name: KELSY BRIKAY WASMUTH, FNP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
6810 STATE ROUTE 162 STE 100
MARYVILLE, IL
ZIP 62062
Phone: (618) 288-3616
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Kelsy Brikay Wasmuth, FNP is a family nurse practitioner in Maryville, IL with 7 years of experience. Kelsy Brikay Wasmuth, FNP NPI is 1336659838. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

6810 STATE ROUTE 162 STE 100
MARYVILLE, IL
ZIP 62062-560
Phone: (618) 288-3616
Fax: (618) 288-3647

The NPI 1336659838 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/10/2017 and was last updated on 2/24/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	209016647	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	209016647	OTHER	ILLINOIS	LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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