Healthcare Provider Details

I. General information

NPI: 1184541179
Provider Name (Legal Business Name): MCKENNA ROSE PRINTY APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N WALL ST
KANKAKEE IL
60901-3483
US

IV. Provider business mailing address

338 LARRY POWER RD
BOURBONNAIS IL
60914-4430
US

V. Phone/Fax

Practice location:
  • Phone: 815-933-1671
  • Fax:
Mailing address:
  • Phone: 815-935-2970
  • Fax: 815-935-2279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209036466
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041486522
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: