Healthcare Provider Details

I. General information

NPI: 1770311748
Provider Name (Legal Business Name): KIRA LYNN SHEEDY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 DRESDEN DR
MORRIS IL
60450-2476
US

IV. Provider business mailing address

1300 DRESDEN DR
MORRIS IL
60450-2476
US

V. Phone/Fax

Practice location:
  • Phone: 815-942-5200
  • Fax:
Mailing address:
  • Phone: 815-942-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209030670
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: