MEDICARE: MISS KELLY MCENTEE APRN

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
1	363LW0102X	Women's Health Nurse Practitioner	041.587136	IL
2	364SW0102X	Women's Health Clinical Nurse Specialist	APRN.CNP.0039570	OH

General Provider Information

NPI Number	:	1639060197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KELLY MCENTEE APRN

Provider Business Mailing Address
First Line	:	4711 GOLF RD STE 920
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-1247
Country	:	US
Telephone Number	:	855-729-2272
Fax Number	:

Provider Business Practice Location Address
First Line	:	4711 GOLF RD STE 920
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-1247
Country	:	US
Telephone Number	:	855-729-2272
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2025
Last Update Date	:	05/21/2026

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