Provider Demographics
NPI:1629447701
Name:CONRAD, KAYLA (FNP-C)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10551 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5328
Mailing Address - Country:US
Mailing Address - Phone:925-949-6691
Mailing Address - Fax:
Practice Address - Street 1:8711 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1166
Practice Address - Country:US
Practice Address - Phone:708-442-7979
Practice Address - Fax:708-442-8574
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA783207163W00000X
CA95005582363LF0000X
IL209021842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse