Provider Demographics
NPI:1720831217
Name:SYLVESTER, KELLY LYNN (RN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:SYLVESTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LYNN
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1128 RIVER BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-6511
Mailing Address - Country:US
Mailing Address - Phone:619-876-7560
Mailing Address - Fax:
Practice Address - Street 1:1128 RIVER BIRCH DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-6511
Practice Address - Country:US
Practice Address - Phone:619-876-7560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041327748163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory CareGroup - Single Specialty