Healthcare Provider Details

I. General information

NPI: 1841117843
Provider Name (Legal Business Name): MELISSA KINDRED APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SHOREWOOD DR
GALENA IL
61036-9583
US

IV. Provider business mailing address

3 SHOREWOOD DR
GALENA IL
61036-9583
US

V. Phone/Fax

Practice location:
  • Phone: 815-291-0874
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1859833
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberH187527
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: