Carroll, Kelly N.

Carroll, Kelly N. is an individual health care provider with primary practice located at 2202 Harlem Rd , Loves Park IL 61111-2754. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered. Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered is her primary health care specialty. Carroll, Kelly N. can be contacted via phone (815) 877-4848.

Contact Information

Primary practice address
2202 Harlem Rd Loves Park IL 61111-2754
Phone: (815) 877-4848
Fax: (815) 636-6125
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 041.363284 Illinois
Nursing Service Providers / Registered Nurse 163W00000X 172314-30 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 209.011923 Illinois

Profile Details

NPI number 1063815645
LBN Legal business name Carroll, Kelly N.
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 26th, 2014
Last updated Mar 28th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063815645 NPPES
Illinois Other F400175500 MEDICARE PTAN
Illinois Other P01459217 MEDICARE PTAN

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