Healthcare Provider Details

I. General information

NPI: 1508782509
Provider Name (Legal Business Name): KLINIVITY HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11836 S HALE AVE
CHICAGO IL
60643-4826
US

IV. Provider business mailing address

11836 S HALE AVE
CHICAGO IL
60643-4826
US

V. Phone/Fax

Practice location:
  • Phone: 630-247-1948
  • Fax:
Mailing address:
  • Phone: 630-247-1948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KAYLA SHILLCUTT
Title or Position: OWNER
Credential:
Phone: 630-247-1948