Provider Demographics
NPI:1619063187
Name:GALBRAITH, KELLY L (APN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:GALBRAITH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:KELLENE
Other - Middle Name:LYNN
Other - Last Name:GALBRAITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:702 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-2814
Mailing Address - Country:US
Mailing Address - Phone:309-557-1400
Mailing Address - Fax:309-557-1461
Practice Address - Street 1:702 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-2814
Practice Address - Country:US
Practice Address - Phone:309-557-1400
Practice Address - Fax:309-557-1461
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-000546363LF0000X
IL309.000186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily