Active NPI
Kennedi Wallace
- Driver
- Chicago Heights, IL
National Provider Identifier
1063322642
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- Practice address
- 90 E Joe Orr Rd
Chicago Heights, IL 60411-1374 - Phone
- (708) 981-9161
- NPI assigned
- Sep 8, 2026
- Last updated
- Sep 8, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | NU | Primary |
Addresses
Primary practice location
90 E Joe Orr Rd
Chicago Heights, IL 60411-1374
Mailing address
2767 Lawlor LN
Naperville, IL 60564-1039
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1788825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788825600000",
"number": "1063322642",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2767 LAWLOR LN",
"city": "NAPERVILLE",
"state": "IL",
"postal_code": "605641039"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 E JOE ORR RD",
"city": "CHICAGO HEIGHTS",
"state": "IL",
"postal_code": "604111374",
"telephone_number": "708-981-9161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "KENNEDI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-09-08",
"last_updated": "2026-09-08",
"certification_date": "2026-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago Heights, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.