Provider Demographics
NPI:1033516935
Name:EYER, KELLY S (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:S
Last Name:EYER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-2241
Mailing Address - Country:US
Mailing Address - Phone:618-392-1301
Mailing Address - Fax:618-392-1302
Practice Address - Street 1:117 E MARKET ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2241
Practice Address - Country:US
Practice Address - Phone:618-392-1301
Practice Address - Fax:618-392-1302
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.378591163W00000X
IL209.01201363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse