Active NPI
Kelly Desmarais, APRN
- Nurse Practitioner
- Peoria, IL
National Provider Identifier
1417830803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 209.032862
- Practice address
- 719 N William Kumpf Blvd Ste 100
Peoria, IL 61605-2531 - Phone
- (309) 624-9934
- NPI assigned
- Jul 31, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 209.032862 | IL | Primary |
Addresses
Primary practice location
719 N William Kumpf Blvd Ste 100
Peoria, IL 61605-2531
Mailing address
15776 Herberger Rd
Mackinaw, IL 61755-9221
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209.032862 | IL | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1753920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753920000000",
"number": "1417830803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15776 HERBERGER RD",
"city": "MACKINAW",
"state": "IL",
"postal_code": "617559221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "719 N WILLIAM KUMPF BLVD STE 100",
"city": "PEORIA",
"state": "IL",
"postal_code": "616052531",
"telephone_number": "309-624-9934"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESMARAIS",
"first_name": "KELLY",
"credential": "APRN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-07-31",
"last_updated": "2025-07-31",
"certification_date": "2025-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IL",
"license": "209.032862",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.