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General NPI Number Information
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NPI Number | 1194285213
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Entity Type | Individual
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Provider Name | CERES K KANGOU APN-CNP
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Gender | Female
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Dates
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Enumeration Date | 03/24/2019
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 9697 191ST ST. SUITE 200 EHMG-BEHAVIORAL HEALTH
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City | MOKENA
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State | IL
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Zip | 60448
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Country | US
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Telephone | 630-646-6540
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Fax | 630-646-6542
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Provider Business Mailing Address
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Address Line | 1111 W LAKE ST
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City | ADDISON
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State | IL
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Zip | 60101-1197
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Country | US
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Telephone | 630-682-7400
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209019061
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 277002135
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License Number State | IL
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