Individual provider · NPI-1

Kelli Lynn Blagg, FNP APN

Nurse Practitioner, Family · Mattoon, IL

NPI number1679676738
StatusActive
Last updated in NPPESSep 18, 2015

Details

NPI
1679676738
Entity type
Individual (NPI-1)
Name
Kelli Lynn Blagg
Credential
FNP APN
Sex
Female
Sole proprietor
No
Enumeration date
Sep 6, 2006
Last updated
Sep 18, 2015

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LF0000X Nurse Practitioner, Family209005102ILYes

Practice location

10555 East County Road 800 N
Mattoon, IL 61938-3574

Phone 217-235-4227 · Fax 217-235-4274

Mailing address

509 Hamacher St 205
Waterloo, IL 62298-1592

Phone 618-628-0715 · Fax 888-371-4468

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