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Individual

MRS. COURTNEY ANN KELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1345 EDWARDS ST STE 2, MORRIS, IL 60450-1692
(815) 942-1421
(815) 488-2033
Mailing address
725 SCHOOL ST STE A, MORRIS, IL 60450-1207
(815) 941-9124
(815) 941-4363

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085003055
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
085.003055
IL LICENSE
IL
Enumeration date
09/24/2007
Last updated
12/17/2020
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