JENNIFER LEE KOLETTIS


Address: 320 E Armstrong Ave, Peoria, IL 61603-3172
Phone: 3096807600

JENNIFER LEE KOLETTIS (NPI# 1790256303) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1790256303
Entity Type Individual
Full Name JENNIFER LEE KOLETTIS
Other Name JENNIFER BERNSTEIN
Credential NP-C
Practice Address 320 E Armstrong Ave
Peoria
IL 61603-3172
Mailing Address 2214 N University St
Peoria
IL 61604-3221
Practice Telephone 3096807600
Practice Fax Number 3094958614
Mailing Telephone 3096807669
Mailing Fax Number 3096818443
Enumeration Date 2018-12-07
Last Update Date 2018-12-07
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LF0000X Nurse Practitioner
Specialization: Family
041-427636 IL Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 320 E ARMSTRONG AVE
City PEORIA
State IL
Zip Code 61603-3172

Providers in the same location

NPI Name Taxonomy Address Enumeration
1487639118 Constance M Freidinger Physician Assistant 320 E Armstrong Ave, Peoria, IL 61603 2005-12-15
1023679180 Thien An Vu Dentist 320 E Armstrong Ave, Peoria, IL 61603-3172 2019-06-27
1356900419 Samer Sabbagh Dentist 320 E Armstrong Ave, Peoria, IL 61603-3172 2019-06-11
1952896417 Shawn Seok-hun Jung Dentist 320 E Armstrong Ave, Peoria, IL 61603 2018-06-27
1992290456 Mariam Bawany Dentist 320 E Armstrong Ave, Peoria, IL 61603-3172 2018-06-27
1982199444 Hardik K Patel Dentist 320 E Armstrong Ave, Peoria, IL 61603-3172 2018-06-27
1508351065 Delna Skariah Dentist 320 E Armstrong Ave, Peoria, IL 61603-3172 2018-06-27
1841726742 Ashley Renee Droege Physician Assistant 320 E Armstrong Ave, Peoria, IL 61603 2017-05-11
1164888483 Osf Saint Francis Medical Center Gpr Program Dentist 320 E Armstrong Ave, Peoria, IL 61603-3172 2016-01-04
1679944219 Jenna Lynn Hamilton Nurse Practitioner 320 E Armstrong Ave, Peoria, IL 61603-3172 2015-10-08
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1598362980 Courtney Klein Nurse Practitioner 1306 N. Berkley Ave, Peoria, IL 61603 2020-10-08
1114588217 Kong Xing Wang Dentist 320 East Armstrong Ave, Peoria, IL 61603 2019-06-28
1073015319 Sara Kristine Rosenbery Nurse Practitioner 515 Ne Glen Oak Ave Ste 202, Peoria, IL 61603 2018-03-02
1861860058 Jennifer Michelle Kelsey Clinical Nurse Specialist 420 Ne Glen Oak Avenue, Suite 401, Peoria, IL 61603 2015-09-04
1467859793 Bonnie Lansing Counselor 617 N Gendale Avenue, Behavioral Health Adult Program, Peoria, IL 61603 2014-12-02
1639597172 Jael K. Mahasi Counselor 1800 Ne Perry Avenue, Peoria, IL 61603 2014-04-02
1992054829 Justin S Ferragut Radiology 530 Northeast Glen Oak Avenue, Peoria, IL 61603 2012-09-06
1780952994 Syed Muhammad Tayyab Internal Medicine 828 Ne Glen Oak Ave Apt No208a, Peoria, IL 61603 2011-12-02
1528389079 St. Francis Medical Center General Acute Care Hospital 530 N E Glen Oak Ave, Peoria, IL 61603 2010-06-18
1780810648 Children's Home Association of Illinois Voluntary or Charitable 400 E. Frye, Peoria, IL 61603 2009-06-05
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Taxonomy Information

Taxonomy Code 363LF0000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Family

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1881295541 Britney Julia Durst Nurse Practitioner 5905 N Prospect Rd, Peoria, IL 61614-4311 2020-11-07
1598362980 Courtney Klein Nurse Practitioner 1306 N. Berkley Ave, Peoria, IL 61603 2020-10-08
1699390039 Steven Joel Schlink Nurse Practitioner 12920 W Roy Rogers Rd, Peoria, AZ 85383-5334 2020-06-11
1457986929 Chanelle Christine Maclin Nurse Practitioner 504 E Kansas St, Peoria, IL 61603-2554 2020-03-05
1225677495 Michelle Chacon Nurse Practitioner 23201 N 87th Dr, Peoria, AZ 85383-1860 2020-01-05
1689218042 Patricia Nwakaego Ayemoba Nurse Practitioner 16018 N 74th Dr, Peoria, AZ 85382-1810 2019-10-29
1144877267 Eunice Wright Nurse Practitioner 26826 N 85th Dr, Peoria, AZ 85383-3624 2019-08-22
1861057507 Shawnee Renee Fudurich Nurse Practitioner 10230 W Happy Valley Pkwy Ste 100, Peoria, AZ 85383-4255 2019-05-08
1265096895 Razel Espiritu Hernandez Nurse Practitioner 25435 N 115th Ave, Peoria, AZ 85383-9789 2019-04-29
1619435310 Jennifer Gayle Ries-clark Nurse Practitioner 8009 W Salter Dr, Peoria, AZ 85382-4440 2019-03-12
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Competitor

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City PEORIA
Zip Code 61603

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Dataset Information

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.

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