Healthcare Provider Details

I. General information

NPI: 1679311559
Provider Name (Legal Business Name): KALEY KIEPURA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10851 BROADWAY
CROWN POINT IN
46307-7303
US

IV. Provider business mailing address

7110 W 127TH ST
PALOS HEIGHTS IL
60463-1571
US

V. Phone/Fax

Practice location:
  • Phone: 219-763-8112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71015502A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209032781
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: