Healthcare Provider Details

I. General information

NPI: 1376972000
Provider Name (Legal Business Name): NAKEISHA NICOLE WEATHERSBY CNM, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W TAYLOR ST
CHICAGO IL
60612-4795
US

IV. Provider business mailing address

1507 E. 53RD ST MAILBOX 402
CHICAGO IL
60615
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone: 773-991-5757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number209010565
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: