Doctor Name: | MRS. KELLY KOOKEN MCCURTAIN |
NPI Number: | 1073850491 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CPNP |
License Number: | 209010107 |
Business Practice Address: | 39w098 Dean Ln St Charles, IL - 601757671 |
Business Phone Number: | 8474044356 |
Business Fax Number: | |
Mailing Address: | 39w098 Dean Ln, ST CHARLES |
State: | IL |
Postal Code: | 601757671 |
Phone Number: | 8474044356 |
Fax Number: | |
NPI Enumeration Date: | 01/04/2013 |
NPI Last Update Date: | 01/04/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | 209010107 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |