KELLY L PERISIN (NPI# 1063909299) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063909299 |
| Entity Type | Individual |
| Full Name | KELLY L PERISIN |
| Other Name | KELLY L KALKOFEN |
| Credential | FNP-C |
| Practice Address |
1650 Washington Ave Alton IL 62002-3931 |
| Mailing Address |
3840 Oscar Ave Alton IL 62002-2123 |
| Practice Telephone | 3146872736 |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2018-11-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 209017367 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363L00000X | Nurse Practitioner | 2018012099 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
2018012099 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 6829 Parker Rd, Florissant, MO 630335308 | 3149957243 |
| Street Address |
1650 WASHINGTON AVE |
| City | ALTON |
| State | IL |
| Zip Code | 62002-3931 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982619151 | Walgreen Co | Pharmacy | 1650 Washington Ave, Alton, IL 62002-3931 | 2006-07-29 |
| 1063996130 | Jodi R Lutz | Nurse Practitioner | 1650 Washington Ave, Alton, IL 62002-3931 | 2018-09-24 |
| 1407374283 | Andrew Cloninger | Pharmacist | 1650 Washington Ave, Alton, IL 62002-3931 | 2017-08-31 |
| 1114336831 | Kerry Studnicki | Pharmacist | 1650 Washington Ave, Alton, IL 62002-3931 | 2014-08-06 |
| 1497021810 | Alfreda Shields | Nurse Practitioner | 1650 Washington Ave, Alton, IL 62002-3931 | 2012-03-29 |
| 1437434529 | Jeremie Studnicki | Pharmacist | 1650 Washington Ave, Alton, IL 62002-3931 | 2011-10-20 |
| 1952685968 | Trina Kelly Huene | Pharmacist | 1650 Washington Ave, Alton, IL 62002-3931 | 2011-10-10 |
| 1083997878 | Angela Mangi | Pharmacist | 1650 Washington Ave, Alton, IL 62002-3931 | 2011-09-28 |
| 1932482882 | Matthew Aaron Fessler | Pharmacist | 1650 Washington Ave, Alton, IL 62002-3931 | 2011-09-27 |
| 1316220650 | Keith Edward Gibson | Pharmacist | 1650 Washington Ave, Alton, IL 62002-3931 | 2011-09-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285272807 | Jersey Community Hospital | Obstetrics & Gynecology | #2 Memorial Drive, Suite 203, Alton, IL 62002 | 2019-12-13 |
| 1912540659 | Kelsi N Harre | Community Health Worker | 2603 N. Rogers Ave., Alton, IL 62002 | 2019-10-25 |
| 1841848322 | Destiny L Miller | Technician | 3429 Meridocia St, Alton, IL 62002 | 2019-08-28 |
| 1942854633 | Jessica Leigh Jump | Speech-Language Pathologist | 453 Bluff Street, Alton, IL 62002 | 2019-07-30 |
| 1194380741 | Vasiliki Kytridou | Dentist | 2800 College Avenue Southern Il University School of De, Building 285, Alton, IL 62002 | 2019-05-08 |
| 1982125910 | Amy Nicole Spalding | Social Worker | 1123 Harrison St, Alton, IL 62002 | 2017-06-29 |
| 1962856310 | Patricia Gregory | Social Worker | 5090 Humbert Rd, Alton, IL 62002 | 2016-04-21 |
| 1447612510 | Alanna Lynn Mcnelly | Chiropractor | 219 Piasa St, Suite 200, Alton, IL 62002 | 2016-03-28 |
| 1174983050 | Roberta's Lovely Ladies Boutique | Mastectomy Fitter | 603 W. Delmar, Alton, IL 62002 | 2016-03-04 |
| 1184081556 | Darcy Graham | Nurse Practitioner | 4 Memorial Dr # 210, Alton, IL 62002 | 2016-01-15 |
| Find all providers in zip 62002 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699255539 | Amanda J. Fucci | Nurse Practitioner | 27 New Durham Rd, Alton, NH 03809-4917 | 2018-08-20 |
| 1083253413 | Lisa Kay James | Nurse Practitioner | 2 Memorial Dr Ste 220, Alton, IL 62002-6723 | 2020-01-02 |
| 1518437672 | Kelsey Marie Browne | Nurse Practitioner | 2 Memorial Dr, Suite 205, Alton, IL 62002-6723 | 2018-12-03 |
| 1023584042 | Tawny Nicole Thomas | Nurse Practitioner | 2 Saint Anthonys Way, Alton, IL 62002-4569 | 2018-10-17 |
| 1063996130 | Jodi R Lutz | Nurse Practitioner | 1650 Washington Ave, Alton, IL 62002-3931 | 2018-09-24 |
| 1992289979 | Roxanne R Strohbeck | Nurse Practitioner | 2 Saint Anthonys Way, Alton, IL 62002-4569 | 2018-09-17 |
| 1861975849 | Colin Michael Solomon | Nurse Practitioner | 2 Saint Anthonys Way, Alton, IL 62002-4569 | 2018-09-14 |
| 1013402544 | Jessica Lynn Riney | Nurse Practitioner | 2 Memorial Dr Ste 220, Alton, IL 62002-6723 | 2018-06-27 |
| 1922515279 | Danielle N Rennie | Nurse Practitioner | 4414 W Center Dr, Alton, IL 62002-5932 | 2018-01-09 |
| 1770025868 | Angela Lytle | Nurse Practitioner | 1 Professional Dr, Alton, IL 62002-5068 | 2016-11-07 |
| Find all providers in ALTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.