Provider Demographics
NPI:1356733927
Name:TRUBY, KELLY (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:TRUBY
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5841 S MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:773-834-6539
Mailing Address - Fax:
Practice Address - Street 1:5841 N MARYLAND AVE
Practice Address - Street 2:MC6098
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-4903
Practice Address - Country:US
Practice Address - Phone:773-702-1278
Practice Address - Fax:773-702-1297
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.011867363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily