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General NPI Number Information
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NPI Number | 1154107845
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Entity Type | Individual
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Provider Name | KENDALL R MOSBY-THOMPSON
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Gender | Male
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Dates
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Enumeration Date | 09/07/2023
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 1500 S FAIRFIELD AVE
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City | CHICAGO
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State | IL
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Zip | 60608-1782
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Country | US
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Telephone | 773-257-4750
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Fax |
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Provider Business Mailing Address
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Address Line | 1713 W WALLEN AVE
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City | CHICAGO
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State | IL
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Zip | 60626-5585
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Country | US
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Telephone | 773-653-9184
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209028233
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041403454
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License Number State | IL
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