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General NPI Number Information
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NPI Number | 1508348590
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Entity Type | Individual
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Provider Name | KELLI EVANS FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/05/2018
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Last Update Date | 10/12/2025
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Provider Practice Location Address
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Address Line | 11200 LINCOLN HWY
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City | MOKENA
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State | IL
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Zip | 60448-8208
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Country | US
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Telephone | 815-464-2171
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Fax |
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Provider Business Mailing Address
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Address Line | 9628 S 49TH AVE
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City | OAK LAWN
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State | IL
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Zip | 60453-3004
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Country | US
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Telephone | 773-895-5619
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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 | 209017955
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 277002256
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License Number State | IL
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