Healthcare Provider Details

I. General information

NPI: 1508618059
Provider Name (Legal Business Name): KAYLEE BYRNE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W TAYLOR ST
CHICAGO IL
60612-4795
US

IV. Provider business mailing address

1815 W AUGUSTA BLVD # 3
CHICAGO IL
60622-4925
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7416
  • Fax: 312-413-8778
Mailing address:
  • Phone: 847-691-2878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209030286
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: