Healthcare Provider Details

I. General information

NPI: 1932542016
Provider Name (Legal Business Name): JASMINE KANAPPILLY APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E KENSINGTON RD
MOUNT PROSPECT IL
60056-1922
US

IV. Provider business mailing address

161 WASHINGTON ST FL 14 EIGHT TOWER BRIDGE, SUITE 1400
CONSHOHOCKEN PA
19428-2083
US

V. Phone/Fax

Practice location:
  • Phone: 866-825-3227
  • Fax:
Mailing address:
  • Phone: 866-825-3227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209010191
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209010191
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: