Provider Demographics
NPI:1881278877
Name:MCCORD, KARI NEWSOM (NP)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:NEWSOM
Last Name:MCCORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:
Other - Last Name:NEWSOM-MCCORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8204 W ROSEBURY DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-2401
Mailing Address - Country:US
Mailing Address - Phone:630-746-6710
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1473
Practice Address - Country:US
Practice Address - Phone:708-503-3345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.023027363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care