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General NPI Number Information
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NPI Number | 1518435247
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Entity Type | Organization
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Legal Business Name | DAVIS FAMILY HEALTH LLC
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Dates
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Enumeration Date | 11/12/2018
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 1201 MERIDEN ST
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City | MENDOTA
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State | IL
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Zip | 61342-2501
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Country | US
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Telephone | 815-538-1800
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Fax | 815-538-4881
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Provider Business Mailing Address
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Address Line | 1201 MERIDEN ST
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City | MENDOTA
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State | IL
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Zip | 61342-2501
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Country | US
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Telephone | 815-538-1800
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Fax | 815-538-4881
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Authorized Official
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Title or Position | PROVIDER/OWNER FULL PRACTICE AUTHOR
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Name | DR. KELLY ANN TONIELLI DAVIS
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Credential | DNP APRN FNP-BC
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Telephone | 815-538-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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