=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457175465
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELSIE WILLIAMS RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2024
-----------------------------------------------------
Last Update Date | 07/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1004 BUTTERFIELD CIR E
-----------------------------------------------------
City | SHOREWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60404-8144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-258-3482
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1004 BUTTERFIELD CIR E
-----------------------------------------------------
City | SHOREWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60404-8144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-258-3482
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 209.036021
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 041450149
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------