Healthcare Provider Details

I. General information

NPI: 1124861497
Provider Name (Legal Business Name): CHELSEY HICKEY APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 10/29/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 WEST AVE STE 108
ORLAND PARK IL
60462-4685
US

IV. Provider business mailing address

15300 WEST AVE STE 108
ORLAND PARK IL
60462
US

V. Phone/Fax

Practice location:
  • Phone: 708-226-2318
  • Fax: 708-226-2319
Mailing address:
  • Phone: 708-226-2318
  • Fax: 708-226-2319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209028664
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209028664
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: