Healthcare Provider Details

I. General information

NPI: 1053657270
Provider Name (Legal Business Name): KIMBERLY ANN MULVEY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY ANN BLOCK APN

II. Dates (important events)

Enumeration Date: 12/15/2012
Last Update Date: 12/08/2024
Certification Date: 12/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 MANCHESTER RD STE 1605
WHEATON IL
60187-4579
US

IV. Provider business mailing address

40 S MAIN ST STE 1300
MEMPHIS TN
38103-5513
US

V. Phone/Fax

Practice location:
  • Phone: 630-866-6010
  • Fax: 630-866-6067
Mailing address:
  • Phone: 866-949-0108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277001219
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277001219
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: