Healthcare Provider Details

I. General information

NPI: 1700650231
Provider Name (Legal Business Name): SHELBY LYNN MEADOWS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHELBY LYNN REEVES

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 08/30/2026
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 N SCHUYLER AVE
KANKAKEE IL
60901-3830
US

IV. Provider business mailing address

1771 N STATE ROUTE 49
CRESCENT CITY IL
60928-7026
US

V. Phone/Fax

Practice location:
  • Phone: 815-939-4422
  • Fax:
Mailing address:
  • Phone: 815-922-9793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number041492042
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: