KELLIE J LUSTENBERGER (NPI# 1295923779) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295923779 |
| Entity Type | Individual |
| Full Name | KELLIE J LUSTENBERGER |
| Credential | N.P. |
| Practice Address |
305 W. Jackson, Suite 100 New Horizons Obstetrics & Gynecology Carbondale IL 62901 |
| Mailing Address |
305 W Jackson St Ste 100 Carbondale IL 62901-1474 |
| Practice Telephone | 6184570404 |
| Practice Fax Number | 6184570440 |
| Mailing Telephone | 6184570404 |
| Mailing Fax Number | 6184570440 |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2008-05-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
209006728 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
305 W. JACKSON, SUITE 100 NEW HORIZONS OBSTETRICS & GYNECOLOGY |
| City | CARBONDALE |
| State | IL |
| Zip Code | 62901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558961268 | Gerad Aaron Harsy | Pharmacist | Walmart Pharmcy, 1450 East Main St, Carbondale, IL 62901 | 2020-10-30 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1306317383 | Rachael O Johnson | Nurse Practitioner | 404 S. Lewis Ln, Carbondale, IL 62901 | 2018-12-17 |
| 1740795194 | Megan Marie Zimmerman | Nurse Practitioner | 1100 W Diann Ln., Carbondale, IL 62901 | 2017-12-07 |
| 1295244242 | Amy Elizabeth Prudencio | Social Worker | 1301 E. Walnut Street, Carbondale, IL 62901 | 2017-09-21 |
| 1740708171 | Theresa Aleise Goodin | Speech-Language Pathologist | 1301 East Walnut Street, Carbondale, IL 62901 | 2017-09-06 |
| 1144762527 | Kathleen Chwalisz Rigney | Psychologist | 306 West Mill Street, Neurorestorative, Carbondale, IL 62901 | 2016-11-16 |
| 1285185173 | Shawnee Health Service and Development Corp | Social Worker | 404 S. Lewis Lane, Carbondale, IL 62901 | 2016-10-17 |
| 1437605094 | Arielle Greer | Nurse's Aide | 510 E. Russell St., A, Carbondale, IL 62901 | 2016-09-01 |
| 1518413863 | Complete Family Eyecare of Carbondale, PC | Optometrist | 1241 East Walnut Street, Carbondale, IL 62901 | 2016-08-28 |
| Find all providers in zip 62901 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023375409 | Natasha Charlyn Shafer | Nurse Practitioner | 1340 Cedar Ct Ste 202, Carbondale, IL 62901 | 2012-04-23 |
| 1649373770 | Valerie Jean Ting | Nurse Practitioner | 3839 Boskydell Rd, Carbondale, IL 62903-7622 | 2006-09-06 |
| 1568071132 | Cynthia Sue Davis | Nurse Practitioner | 405 W Jackson St, Carbondale, IL 62901-1462 | 2020-07-29 |
| 1306465919 | Michelle Corzine | Nurse Practitioner | 404 S Lewis Ln, Carbondale, IL 62901-3547 | 2020-04-14 |
| 1457823056 | Tiffany Hicks Gardner | Nurse Practitioner | 1155 Cedar Ct, Carbondale, IL 62901-5333 | 2018-12-19 |
| 1609388545 | Rina Elizabeth Caslow | Nurse Practitioner | 405 W Jackson St, Carbondale, IL 62901 | 2017-11-01 |
| 1407366123 | Ariele N. Loiacono | Nurse Practitioner | 1100 W Diann Ln, Carbondale, IL 62901-5339 | 2017-10-08 |
| 1073030789 | Carrie Ann Lutman | Nurse Practitioner | 2250 N Illinois Ave, Carbondale, IL 62901-5612 | 2017-08-23 |
| 1699120055 | Jessica Serena Marie Belobraydic | Nurse Practitioner | 405 W Jackson St, Carbondale, IL 62902-9000 | 2016-05-04 |
| 1225499825 | Ashley Nicole Freeman | Nurse Practitioner | 305 W Jackson St, Ste 103, Carbondale, IL 62901 | 2016-03-10 |
| Find all providers in CARBONDALE | ||||
| City | CARBONDALE |
| Zip Code | 62901 |
Please comment or provide details below to improve the information on KELLIE J LUSTENBERGER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.