Provider Demographics
NPI:1740093798
Name:HAMM, KASSIDY (FNP)
Entity type:Individual
Prefix:
First Name:KASSIDY
Middle Name:
Last Name:HAMM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5521 S KEDZIE AVE UNIT 106
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-2448
Mailing Address - Country:US
Mailing Address - Phone:773-306-2546
Mailing Address - Fax:
Practice Address - Street 1:5521 S KEDZIE AVE UNIT 106
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-2448
Practice Address - Country:US
Practice Address - Phone:773-306-2546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209031237363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner