Provider Demographics
NPI:1396283495
Name:HARKEY, KELLI L (NP-C)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:L
Last Name:HARKEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27W350 HIGH LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1262
Mailing Address - Country:US
Mailing Address - Phone:630-933-4000
Mailing Address - Fax:630-933-1933
Practice Address - Street 1:27W350 HIGH LAKE RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1262
Practice Address - Country:US
Practice Address - Phone:630-933-4000
Practice Address - Fax:630-933-1933
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020754363L00000X, 363L00000X
SD20807363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20807OtherSC BOARD OF NURSING
NC5009278OtherNORTH CAROLINA BOARD OF NURSING/MEDICAL BOARD