Provider Demographics
NPI:1013453471
Name:NEIRYNCK, KELLY (LPN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:NEIRYNCK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E MILL ST
Mailing Address - Street 2:
Mailing Address - City:KEWANEE
Mailing Address - State:IL
Mailing Address - Zip Code:61443-3547
Mailing Address - Country:US
Mailing Address - Phone:309-525-3598
Mailing Address - Fax:
Practice Address - Street 1:420 E MILL ST
Practice Address - Street 2:
Practice Address - City:KEWANEE
Practice Address - State:IL
Practice Address - Zip Code:61443
Practice Address - Country:US
Practice Address - Phone:309-525-3598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043.103031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse