Provider Demographics
NPI:1619442555
Name:KEMPER, MALINDA (FNP)
Entity type:Individual
Prefix:
First Name:MALINDA
Middle Name:
Last Name:KEMPER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 W CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-1374
Mailing Address - Country:US
Mailing Address - Phone:618-946-9489
Mailing Address - Fax:
Practice Address - Street 1:6277 CENTER GROVE RD
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3309
Practice Address - Country:US
Practice Address - Phone:618-659-0605
Practice Address - Fax:618-659-0627
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2024-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily