Healthcare Provider Details

I. General information

NPI: 1689123283
Provider Name (Legal Business Name): KIMBERLY KUSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2016
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 S RANDALL RD
ALGONQUIN IL
60102-9775
US

IV. Provider business mailing address

235 DOLE AVE
CRYSTAL LAKE IL
60014-5732
US

V. Phone/Fax

Practice location:
  • Phone: 224-442-3000
  • Fax:
Mailing address:
  • Phone: 847-630-5465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209014039
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277-001811
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277-001811
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: