Healthcare Provider Details

I. General information

NPI: 1124604517
Provider Name (Legal Business Name): KRISTS KLEGERIS PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1786 MOON LAKE BLVD STE 104
HOFFMAN ESTATES IL
60169-1016
US

IV. Provider business mailing address

1786 MOON LAKE BLVD STE 104
HOFFMAN ESTATES IL
60169-1016
US

V. Phone/Fax

Practice location:
  • Phone: 847-755-8090
  • Fax:
Mailing address:
  • Phone: 847-755-8090
  • Fax: 847-843-7393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209023062
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: