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Individual

KENDALL R MOSBY-THOMPSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1500 S FAIRFIELD AVE, CHICAGO, IL 60608-1782
(773) 257-4750
Mailing address
1713 W WALLEN AVE, CHICAGO, IL 60626-5585
(773) 653-9184

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041403454
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209028233
IL

Other

Enumeration date
09/07/2023
Last updated
09/07/2023
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