Healthcare Provider Details

I. General information

NPI: 1457175465
Provider Name (Legal Business Name): KELSIE WILLIAMS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 W 143RD ST
ORLAND PARK IL
60467-1923
US

IV. Provider business mailing address

11201 W 143RD ST
ORLAND PARK IL
60467-1923
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.036021
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: