Provider Demographics
NPI:1225553803
Name:DAVIS, KELLY ANN TONIELLI (DNP APRN FNP-BC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANN TONIELLI
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DNP APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 MERIDEN ST
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-2501
Mailing Address - Country:US
Mailing Address - Phone:815-538-1800
Mailing Address - Fax:815-538-4881
Practice Address - Street 1:1201 MERIDEN ST
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:IL
Practice Address - Zip Code:61342-2501
Practice Address - Country:US
Practice Address - Phone:815-538-1800
Practice Address - Fax:815-538-4881
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2025-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000333363LP0200X, 363LA2200X, 363LP0808X, 363LW0102X
IL2016031102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health