Healthcare Provider Details

I. General information

NPI: 1275406183
Provider Name (Legal Business Name): HELENA KEVORKIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date: 10/30/2025
Reactivation Date: 11/26/2025

III. Provider practice location address

95 S CHICAGO ST
JOLIET IL
60436-1745
US

IV. Provider business mailing address

9551 171ST ST
TINLEY PARK IL
60487-6109
US

V. Phone/Fax

Practice location:
  • Phone: 815-740-5561
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.033739
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.484198
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: