KELLY A PETERSON (NPI# 1255965208) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255965208 |
| Entity Type | Individual |
| Full Name | KELLY A PETERSON |
| Practice Address |
225 E Chicago Ave Chicago IL 60611-2991 |
| Mailing Address |
12516 S 71st Ct Palos Heights IL 60463-1550 |
| Practice Telephone | 3122274000 |
| Mailing Telephone | 7087681694 |
| Enumeration Date | 2020-02-28 |
| Last Update Date | 2020-02-28 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LN0005X |
Nurse Practitioner Specialization: Neonatal, Critical Care |
209.020968 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | HEALTH INSURANCE | EAD821145963 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013450907 | Kelly Rose Peterson | Physical Therapist | 1190 Baker St Ste 105, Costa Mesa, CA 92626-4105 | 2016-11-23 |
| 1326437120 | Kelly Leigh Peterson | Nurse Practitioner | 2200 Childrens Way Monroe Carell Jr, Doctor's Office Tower, 7th Floor, Suite 7100, Nashville, TN 37232-0001 | 2015-01-16 |
| 1336424027 | Kelly Rae Peterson | Nurse Anesthetist, Certified Registered | 9803 Vagabond Ln N, Maple Grove, MN 55311-1364 | 2011-10-13 |
| 1235413758 | Kelly Suzanne Peterson | Naturopath | 638 Fulton St W Suite B, Grand Rapids, MI 49504 | 2011-10-03 |
| 1710016563 | Kelly Peterson | Counselor | 5240 Ne Elam Young Pkwy Ste 100, Hillsboro, OR 97124 | 2007-03-05 |
| 1558399261 | Kelly B Peterson | Dentist | 5100 Grove St, Ste B, Marysville, WA 98270-4492 | 2006-06-29 |
| 1639787872 | Kelly Peterson | Military Health Care Provider | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-07-14 |
| 1639720014 | Kelly Ann Peterson | Counselor | 20288 Highway 15 N Ste 100, Hutchinson, MN 55350-5685 | 2019-09-26 |
| 1164087730 | Kelly Peterson | Registered Nurse | 410 W 10th Ave, Columbus, OH 43210-1240 | 2019-05-08 |
| 1366923963 | Kelly Peterson | Counselor | 205 Burlington Rd, Bedford, MA 01730-1406 | 2018-08-22 |
| Street Address |
225 E CHICAGO AVE |
| City | CHICAGO |
| State | IL |
| Zip Code | 60611-2991 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790779734 | Martha Cotsen Saker | Radiology | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2005-09-06 |
| 1356942239 | Sara Mancuso | Nurse Practitioner | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2020-11-05 |
| 1912514423 | Emily May Wilson | Audiologist | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2020-09-29 |
| 1780291617 | Loretta Lavigne | Social Worker | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2020-09-24 |
| 1275149312 | Abigail Hadley | Registered Nurse | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2020-09-22 |
| 1326653866 | Lauren Spradling | Dietitian, Registered | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2020-09-11 |
| 1629682232 | Agnes Kim | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2020-09-01 | |
| 1861006405 | Samantha A Grooss | Dietitian, Registered | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2020-09-01 |
| 1255945838 | Patrice H. Swiontek | Dietitian, Registered | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2020-09-01 |
| 1205440088 | Lisa Sharda | Dietitian, Registered | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2020-08-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861092835 | Lauren Less | Social Worker | 111 East Pearson St, Chicago, IL 60611 | 2020-10-29 |
| 1134735962 | Kalvin Cheuk Hang Lung | Student in an Organized Health Care Education/Training Program | 675 N St Clair St 17th Floor, Chicago, IL 60611 | 2020-09-17 |
| 1487267845 | Ashley Marie Sablich | Student in an Organized Health Care Education/Training Program | 250 E Huron Street, Suite 1-200, Chicago, IL 60611 | 2020-08-26 |
| 1245854033 | Danielle Humphrey | Student in an Organized Health Care Education/Training Program | Pa Program, Suite 1-200, 240 East Huron Street, Chicago, IL 60611 | 2020-06-08 |
| 1801418074 | Sana Healing Collective | Clinic/Center | 405 N. Wabash Street, Chicago, IL 60611 | 2020-05-11 |
| 1194359489 | Insight:eating Disorders, Weight Management & Psychological Centers | Psychiatric Hospital | 1 E. Erie Street, 4th Floor, Chicago, IL 60611 | 2020-02-26 |
| 1902439193 | Iwona Boska | Nurse Practitioner | 676 N St.clair Street, Suite 2140, Chicago, IL 60611 | 2020-02-17 |
| 1922643576 | Sarah Elizabeth Schwartzer | Audiologist | Chicago Dizziness and Hearing, 645 North Michigan Avenue, Suite 410, Chicago, IL 60611 | 2019-11-07 |
| 1023668852 | Anne Marguerite Davidson | Student in an Organized Health Care Education/Training Program | Mcgraw Medical Center, 240 E Huron Street, Suite 1-200, Chicago, IL 60611 | 2019-09-13 |
| 1871141085 | Coast Management | Durable Medical Equipment & Medical Supplies | 40 E. Chicago Ave, Suite 149, Chicago, IL 60611 | 2019-08-30 |
| Find all providers in zip 60611 | ||||
| Taxonomy Code | 363LN0005X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Neonatal, Critical Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699229229 | Christie Gilbart | Nurse Practitioner | 537 W Belmont Ave, #3, Chicago, IL 60657-4677 | 2016-08-11 |
| 1811124936 | Denise Kirsten | Nurse Practitioner | 1653 W. Congress, Pkwy Nicu, Chicago, IL 60612 | 2009-06-16 |
| 1356942239 | Sara Mancuso | Nurse Practitioner | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2020-11-05 |
| 1912516667 | Raymond Vincent Garay | Nurse Practitioner | 1620 W Harrison St, Chicago, IL 60612-3801 | 2020-07-29 |
| 1710510433 | Helen Medina | Nurse Practitioner | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2020-02-20 |
| 1164053484 | Amber Sara Johnson | Nurse Practitioner | 5841 S Maryland Ave, Chicago, IL 60637-1443 | 2020-01-27 |
| 1275190647 | Hyebin Hailey Lee | Nurse Practitioner | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2019-05-21 |
| 1396200697 | Jennifer Pykosz | Nurse Practitioner | 1653 W Congress Pkwy, Chicago, IL 60612-3833 | 2019-01-31 |
| 1134635147 | Margaret Connors | Nurse Practitioner | 5721 S Maryland Ave, Chicago, IL 60637-1425 | 2017-12-28 |
| 1538685581 | Kasey Mccormick | Nurse Practitioner | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2017-08-21 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.