Provider Demographics
NPI:1255754529
Name:ALLEN-LAMPE, KI RISTIA J (APN)
Entity type:Individual
Prefix:
First Name:KI RISTIA
Middle Name:J
Last Name:ALLEN-LAMPE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ROUNTREE ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62049-1509
Mailing Address - Country:US
Mailing Address - Phone:217-532-9471
Mailing Address - Fax:
Practice Address - Street 1:1116 HARTMAN LN
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62221-8014
Practice Address - Country:US
Practice Address - Phone:618-641-9011
Practice Address - Fax:618-641-9017
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013474363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily