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General NPI Number Information
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NPI Number | 1699315697
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Entity Type | Individual
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Provider Name | KELSEY L PROEHL FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/08/2020
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 21660 W FIELD PKWY
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City | DEER PARK
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State | IL
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Zip | 60010-7265
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Country | US
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Telephone | 888-803-3370
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Fax |
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Provider Business Mailing Address
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Address Line | 2894 SAND OAK LOOP
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City | APOPKA
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State | FL
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Zip | 32712-1438
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Country | US
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Telephone | 517-202-0836
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Fax | 517-202-0836
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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 | 95036398
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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 | 61331449
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License Number State | WA
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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 | 277.00235
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License Number State | IL
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