Provider Demographics
NPI:1912249921
Name:VAN ASSCHE, KELLY RENEE (ARNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:RENEE
Last Name:VAN ASSCHE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W KINZIE ST
Mailing Address - Street 2:APT 2311
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-5727
Mailing Address - Country:US
Mailing Address - Phone:540-435-6224
Mailing Address - Fax:
Practice Address - Street 1:5825 PLANK RD STE 105
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-5207
Practice Address - Country:US
Practice Address - Phone:540-785-3448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013843363LA2100X
FLARNP9325787363LA2100X
MI4704340907363LA2100X
VA0024182844363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care