Healthcare Provider Details

I. General information

NPI: 1952744963
Provider Name (Legal Business Name): KELLY CANERDAY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6309 W 95TH ST
OAK LAWN IL
60453-2201
US

IV. Provider business mailing address

6309 W 95TH ST
OAK LAWN IL
60453-2201
US

V. Phone/Fax

Practice location:
  • Phone: 708-390-9483
  • Fax: 844-689-3212
Mailing address:
  • Phone: 708-390-9483
  • Fax: 844-689-3212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209010147
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: