Provider Demographics
NPI:1073310900
Name:ELDER, KRISTY JO (RN)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:JO
Last Name:ELDER
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 CLOVER CT
Mailing Address - Street 2:
Mailing Address - City:GIBSON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60936-1902
Mailing Address - Country:US
Mailing Address - Phone:217-778-4372
Mailing Address - Fax:
Practice Address - Street 1:509 CLOVER CT
Practice Address - Street 2:
Practice Address - City:GIBSON CITY
Practice Address - State:IL
Practice Address - Zip Code:60936-1902
Practice Address - Country:US
Practice Address - Phone:217-778-4372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041361150163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management