Provider Demographics
NPI:1376066118
Name:FRANZEN, KELLIE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:
Last Name:FRANZEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 E WASHINGTON ST STE D
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-4310
Mailing Address - Country:US
Mailing Address - Phone:888-240-1121
Mailing Address - Fax:888-496-0086
Practice Address - Street 1:2103 E WASHINGTON ST STE D
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-4310
Practice Address - Country:US
Practice Address - Phone:888-240-1121
Practice Address - Fax:888-496-0086
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily