Healthcare Provider Details

I. General information

NPI: 1659854198
Provider Name (Legal Business Name): KEZIA PHILIPS APN-DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 05/15/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W LAKE ST STE 200
ADDISON IL
60101-2500
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 331-221-9001
  • Fax: 331-221-3971
Mailing address:
  • Phone: 847-982-3175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209017751
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.017751
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: