Provider Demographics
NPI:1386172922
Name:SMITH, KELSEY (RN, FNP-C)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:HENSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5746 W WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2657
Mailing Address - Country:US
Mailing Address - Phone:314-971-3029
Mailing Address - Fax:
Practice Address - Street 1:680 N LAKE SHORE DR STE 1200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-8702
Practice Address - Country:US
Practice Address - Phone:312-440-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily