KELLIE J LUSTENBERGER N.P. NPI 1295923779

NPI Information

NPI: 1295923779
Provider Name: KELLIE J LUSTENBERGER, N.P.
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
305 W. JACKSON, SUITE 100
NEW HORIZONS OBSTETRICS & GYNECOLOGY
CARBONDALE, IL
ZIP 62901
Phone: (618) 457-0404
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Kellie J Lustenberger, N.P. is a family nurse practitioner in Carbondale, IL with 17 years of experience. Kellie J Lustenberger, N.P. NPI is 1295923779. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

305 W. JACKSON, SUITE 100
NEW HORIZONS OBSTETRICS & GYNECOLOGY
CARBONDALE, IL
ZIP 62901
Phone: (618) 457-0404
Fax: (618) 457-0440

The NPI 1295923779 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/9/2007 and was last updated on 5/14/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	209006728	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	K50464	MEDICARE PIN	ILLINOIS
2	709920	MEDICARE PIN	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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