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NPI Code Detail

MEDICARE: KELLY RANAE DAVIS APN

MEDICARE: KELLY RANAE DAVIS APN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner209023957IL
2363LF0000XFamily Nurse PractitionerA165295IA

General Provider Information

NPI Number : 1265109409
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY RANAE DAVIS APN
Provider Business Mailing Address
First Line : 2500 W HIGGINS RD STE 1040
Second Line :
City : HOFFMAN ESTATES
State : IL
Zip : 60169-2049
Country : US
Telephone Number : 847-884-8096
Fax Number : 847-884-8125
Provider Business Practice Location Address
First Line : 2500 W HIGGINS RD STE 1040
Second Line :
City : HOFFMAN ESTATES
State : IL
Zip : 60169-2049
Country : US
Telephone Number : 847-884-8096
Fax Number : 847-884-8125
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2021
Last Update Date : 08/18/2023

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