Healthcare Provider Details

I. General information

NPI: 1447717525
Provider Name (Legal Business Name): KELLY J ABRAMS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 FRANKLIN AVE
NORMAL IL
61761-3551
US

IV. Provider business mailing address

611 W PARK ST FAPC
URBANA IL
61801-2529
US

V. Phone/Fax

Practice location:
  • Phone: 309-556-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209018846
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: