Healthcare Provider Details

I. General information

NPI: 1326373663
Provider Name (Legal Business Name): KELLY K. BHATIA APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE EV ICU 4945
EVANSTON IL
60201-1718
US

IV. Provider business mailing address

2650 RIDGE AVE STE 4945
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2000
  • Fax:
Mailing address:
  • Phone: 847-570-4103
  • Fax: 847-570-1436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number209007747
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: