Provider Demographics
NPI:1194547976
Name:MEHRABIAN, KEIMIA (FNP)
Entity type:Individual
Prefix:
First Name:KEIMIA
Middle Name:
Last Name:MEHRABIAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 W SAINT PAUL AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5342
Mailing Address - Country:US
Mailing Address - Phone:832-294-8742
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST STE 1159
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3883
Practice Address - Country:US
Practice Address - Phone:312-942-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-31
Last Update Date:2025-01-14
Deactivation Date:2024-12-30
Deactivation Code:
Reactivation Date:2025-01-13
Provider Licenses
StateLicense IDTaxonomies
IL209030620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily