Provider Demographics
NPI:1528517059
Name:ROXAS KELLY, LYNN (CNM, NP)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:ROXAS KELLY
Suffix:
Gender:F
Credentials:CNM, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11019 SHENANDOAH DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-9414
Mailing Address - Country:US
Mailing Address - Phone:708-307-5594
Mailing Address - Fax:773-646-3955
Practice Address - Street 1:17850 KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2058
Practice Address - Country:US
Practice Address - Phone:312-550-3254
Practice Address - Fax:708-799-4805
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209014909363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology