Provider Demographics
NPI:1073850491
Name:MCCURTAIN, KELLY KOOKEN (CPNP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:KOOKEN
Last Name:MCCURTAIN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2800 KESLINGER RD STE 160
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-3753
Mailing Address - Country:US
Mailing Address - Phone:630-232-7200
Mailing Address - Fax:630-232-2288
Practice Address - Street 1:2800 KESLINGER RD STE 160
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-3753
Practice Address - Country:US
Practice Address - Phone:630-232-7200
Practice Address - Fax:630-232-2288
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010107363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics