Healthcare Provider Details

I. General information

NPI: 1053191460
Provider Name (Legal Business Name): JULIA KEARNS APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE FL 3
EVANSTON IL
60201-1700
US

IV. Provider business mailing address

14 BRADFORD LN
OAK BROOK IL
60523-2322
US

V. Phone/Fax

Practice location:
  • Phone: 609-402-7610
  • Fax:
Mailing address:
  • Phone: 609-402-7610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209027888
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209027888
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: