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General NPI Number Information
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NPI Number | 1629447701
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Entity Type | Individual
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Provider Name | KAYLA CONRAD FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | 8711 W CERMAK RD
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City | NORTH RIVERSIDE
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State | IL
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Zip | 60546-1166
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Country | US
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Telephone | 708-442-7979
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Fax | 708-442-8574
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Provider Business Mailing Address
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Address Line | 10551 WINDSOR DR
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City | WESTCHESTER
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State | IL
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Zip | 60154-5328
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Country | US
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Telephone | 925-949-6691
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 783207
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95005582
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209021842
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License Number State | IL
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