Healthcare Provider Details

I. General information

NPI: 1093083420
Provider Name (Legal Business Name): KENYA KAWANEE HEMINGWAY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 03/22/2025
Certification Date: 03/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1858 W 35TH ST STE B
CHICAGO IL
60609-1201
US

IV. Provider business mailing address

1858 W 35TH ST STE B
CHICAGO IL
60609-1201
US

V. Phone/Fax

Practice location:
  • Phone: 773-940-2062
  • Fax: 773-940-2061
Mailing address:
  • Phone: 773-940-2062
  • Fax: 773-940-2061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041349530
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209009143
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License Number277000919
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277000919
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: