Provider Demographics
NPI:1891358222
Name:ERKE, KELLY JO (APRN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JO
Last Name:ERKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:JO
Other - Last Name:MAHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20830 N 1970 EAST RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61834-6228
Mailing Address - Country:US
Mailing Address - Phone:217-260-1853
Mailing Address - Fax:
Practice Address - Street 1:20830 N 1970 EAST RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61834-6228
Practice Address - Country:US
Practice Address - Phone:217-260-1853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.18486363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology