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1639060197 NPI number — KELLY MCENTEE APRN

NPI Number: 1639060197
Health Care Provider/Practitioner: KELLY MCENTEE APRN

Information about “1639060197” NPI (KELLY MCENTEE APRN) exists in 1639060197 in HTML format HTML  |  1639060197 in plain Text format TXT  |  1639060197 in PDF (Portable Document Format) PDF  |  1639060197 in an XML format XML  formats.

NPI Number : 1639060197 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639060197",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCENTEE",
    "FirstName": "KELLY",
    "MiddleName": null,
    "NamePrefix": "MISS",
    "NameSuffix": null,
    "Credential": "APRN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "110 S RIVER RD STE 7",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DES PLAINES",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60016-3440",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "847-294-9614",
    "MailingAddressFaxNumber": "847-294-9644",
    "FirstLinePracticeLocationAddress": "110 S RIVER RD STE 7",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DES PLAINES",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60016-3440",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "847-294-9614",
    "PracticeLocationAddressFaxNumber": "847-294-9644",
    "EnumerationDate": "07/14/2025",
    "LastUpdateDate": "12/22/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LW0102X",
          "TaxonomyName": "Women's Health Nurse Practitioner",
          "LicenseNumber": "041.587136",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "364SW0102X",
          "TaxonomyName": "Women's Health Clinical Nurse Specialist",
          "LicenseNumber": "APRN.CNP.0039570",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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