Healthcare Provider Details

I. General information

NPI: 1689542466
Provider Name (Legal Business Name): KELLY JEAN PURCELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 N HUNT CLUB RD STE 100
GURNEE IL
60031-2632
US

IV. Provider business mailing address

PO BOX 1306
PARK RIDGE IL
60068-7306
US

V. Phone/Fax

Practice location:
  • Phone: 847-548-2200
  • Fax: 547-548-2865
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.011380
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: