NPI Profile for KILEY M FAIRES in BELLEVILLE, IL.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Family |
363LF0000X | 50 | Nurse Practitioner |
| NPI # | 1366806838 |
|
| Status | Active | |
| Credentials | FNP-BC (Family Nurse Practitioner) | |
| Entity | Individual | |
| Enumeration date | 04/11/2016 | |
| Last updated | 02/04/2021 - About 5 years ago | |
| Sole proprietor 1 | No | |
| Identifiers |
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|
| Hospital affiliation(s) | Not Available |
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KILEY M FAIRES
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