Provider Demographics
NPI:1851524011
Name:MCKINSTRY, CAROLE H (NP)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:H
Last Name:MCKINSTRY
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:2 SAINT ANTHONYS WAY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-4569
Mailing Address - Country:US
Mailing Address - Phone:618-462-2277
Mailing Address - Fax:618-463-9342
Practice Address - Street 1:2 SAINT ANTHONYS WAY
Practice Address - Street 2:SUITE 305
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4569
Practice Address - Country:US
Practice Address - Phone:618-462-2277
Practice Address - Fax:618-463-9342
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2011-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL209007691363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209007691OtherLICENSE NUMBER-ILLINOIS