Provider Demographics
NPI:1427213388
Name:KULAGIN, KELLY JO (MS, RN, ACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JO
Last Name:KULAGIN
Suffix:
Gender:F
Credentials:MS, RN, ACNP-BC
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:JO
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RN, ACNP-BC
Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:RUSH UNIV MED CTR, NEUROLOGICAL SCIENCES, SUITE 1106
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-942-4500
Mailing Address - Fax:312-563-2206
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:RUSH UNIV MED CTR, NEUROLOGICAL SCIENCES, SUITE 1106
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-942-4500
Practice Address - Fax:312-563-2206
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2012-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007143363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care