Healthcare Provider Details

I. General information

NPI: 1851239487
Provider Name (Legal Business Name): KAITLYN CHENEY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 GRAND AVE # 1106
GURNEE IL
60031-4591
US

IV. Provider business mailing address

6615 GRAND AVE # 1106
GURNEE IL
60031-4591
US

V. Phone/Fax

Practice location:
  • Phone: 217-778-6885
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209035089
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: