Provider Demographics
NPI:1366467755
Name:TOENNIES, KRISTI M (NP)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:M
Last Name:TOENNIES
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1052 MARTIN LUTHER KING DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3002
Mailing Address - Country:US
Mailing Address - Phone:618-436-5410
Mailing Address - Fax:618-436-8063
Practice Address - Street 1:210 W. MCKINLEY AVE
Practice Address - Street 2:STE 1
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526
Practice Address - Country:US
Practice Address - Phone:217-876-6600
Practice Address - Fax:217-876-6606
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO137122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209004197Medicaid
IL209004197Medicaid
P38696Medicare UPIN
K47991Medicare PIN