Provider Demographics
NPI:1619730686
Name:KNOWLES, KELLEY ANN (RN BSN PEL-CSN)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:ANN
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:RN BSN PEL-CSN
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:MILLER KNOWLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:910 W TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60425-1322
Mailing Address - Country:US
Mailing Address - Phone:708-856-9530
Mailing Address - Fax:
Practice Address - Street 1:601 WILLOW ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1140
Practice Address - Country:US
Practice Address - Phone:815-806-4686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041256604163WH0200X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WH0200XNursing Service ProvidersRegistered NurseHome Health