Healthcare Provider Details

I. General information

NPI: 1497264865
Provider Name (Legal Business Name): JOSEPH PATRICK CARNEY FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N WALL ST
KANKAKEE IL
60901-2901
US

IV. Provider business mailing address

548 DIVERSATECH DR S
MANTENO IL
60950-3561
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-7500
  • Fax:
Mailing address:
  • Phone: 815-325-5785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209-016590
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: