Provider Demographics
NPI:1912465303
Name:FAGBEMI, KEHINDE CHRISTIANA (NP)
Entity Type:Individual
Prefix:MRS
First Name:KEHINDE
Middle Name:CHRISTIANA
Last Name:FAGBEMI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 E 45TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-3421
Mailing Address - Country:US
Mailing Address - Phone:708-662-0493
Mailing Address - Fax:
Practice Address - Street 1:516 E 45TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-3421
Practice Address - Country:US
Practice Address - Phone:708-662-0493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018916363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner