Healthcare Provider Details

I. General information

NPI: 1629447701
Provider Name (Legal Business Name): KAYLA CONRAD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8711 W CERMAK RD
NORTH RIVERSIDE IL
60546-1166
US

IV. Provider business mailing address

10551 WINDSOR DR
WESTCHESTER IL
60154-5328
US

V. Phone/Fax

Practice location:
  • Phone: 708-442-7979
  • Fax: 708-442-8574
Mailing address:
  • Phone: 925-949-6691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209021842
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number783207
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95005582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: