Provider Demographics
NPI:1205532041
Name:PERDUE, KRYSTAL DARNELL (NP)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:DARNELL
Last Name:PERDUE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2376 KNOX ROAD 900 N
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:61529-9355
Mailing Address - Country:US
Mailing Address - Phone:309-231-5326
Mailing Address - Fax:
Practice Address - Street 1:1001 MAIN ST STE 500A
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61606-2038
Practice Address - Country:US
Practice Address - Phone:309-495-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.026009363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care