Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kyle Ryan Faris, ACNPC-AG

Individual provider Gerontology Nurse Practitioner · NPI 1588480685

Kyle Ryan Faris, ACNPC-AG is a Nurse Practitioner in Peoria, Illinois. Qualified in 2024, 2 years ago. Practices with Osf Multi-Specialty Group, a 2,128-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
2
Licensed in
IL
In the registry since
2024
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

1001 Main St Ste 200
Peoria, IL 61606-2035
Phone: (309) 672-5682
Fax: (309) 672-3147
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 747 Broadway, Seattle, WA 98122-4307 — (206) 215-3407

Specialties & licences

Gerontology Nurse Practitioner (primary) Taxonomy 363LG0600X · Licence 209032698 (IL)

Record details

NPI number1588480685
Entity typeIndividual (Type 1)
GenderMale
Credentials ACNPC-AG
Sole proprietorYes
NPI enumeratedNovember 23, 2024
Last updated in NPPESJuly 12, 2025
Certification dateJuly 12, 2025
Mailing address10210 Ne 189th St Unit A, Bothell, WA 98011-3836

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Osf Multi-Specialty Group — 2128 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Peoria