Individual
DR. WILLIAM THOMAS KELLY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP, RN, APN, AGACNP
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-5118
Mailing address
1122 W CATALPA AVE APT 605, CHICAGO, IL 60640-7084
(773) 960-8606
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
209.017727
IL
Other
Enumeration date
05/26/2018
Last updated
05/26/2018
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