Healthcare Provider Details

I. General information

NPI: 1124737119
Provider Name (Legal Business Name): KELLY LYNN METCALF APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CENTRAL ST
EVANSTON IL
60201-1777
US

IV. Provider business mailing address

1331 ASHLAND AVE
EVANSTON IL
60201-4039
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-1410
  • Fax:
Mailing address:
  • Phone: 815-757-5638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209026184
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209026184
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: