Healthcare Provider Details

I. General information

NPI: 1356716989
Provider Name (Legal Business Name): KELLY MORRIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MADISON ST SUITE 300
JOLIET IL
60435
US

IV. Provider business mailing address

1000 REMINGTON BLVD STE 100
BOLINGBROOK IL
60440-4707
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-7133
  • Fax: 815-725-4863
Mailing address:
  • Phone:
  • Fax: 630-914-2469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209013651
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: