MEDICARE: ELEVATED HEALTH & WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1205624186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATED HEALTH & WELLNESS

Provider Business Mailing Address
First Line	:	9624 S LOWE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-1011
Country	:	US
Telephone Number	:	773-491-4141
Fax Number	:

Provider Business Practice Location Address
First Line	:	2315 E 93RD ST STE 339
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-3916
Country	:	US
Telephone Number	:	312-927-1897
Fax Number	:	949-703-8941

Authorized Official
Title or Position	:	APRN, FNP-C
Name	:	MS. KEYONA GAYLES
Credential	:	MSN, FNP
Telephone Number	:	773-491-4141

Provider Enumeration Date	:	04/29/2025
Last Update Date	:	04/29/2025

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Directions to “ELEVATED HEALTH & WELLNESS ” Practice Location

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