Healthcare Provider Details

I. General information

NPI: 1669028312
Provider Name (Legal Business Name): KEYONA DENA GAYLES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. KEYONA DENA GAYLES

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 167TH ST STE 3
TINLEY PARK IL
60477-2078
US

IV. Provider business mailing address

6700 167TH ST STE 3
TINLEY PARK IL
60477-2078
US

V. Phone/Fax

Practice location:
  • Phone: 312-927-1897
  • Fax: 773-825-8277
Mailing address:
  • Phone: 312-927-1897
  • Fax: 773-825-8277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277.004183
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: