William Thomas Kelly III, DNP, RN, APN, AGACNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

209.017727 Issued in IL

Practice address

2160 S 1St Ave
Maywood, IL 60153-3328

Phone

(708) 216-5118

NPI assigned

May 26, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527292800000",
    "number": "1215428156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1122 W CATALPA AVE APT 605",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606407084",
            "telephone_number": "773-960-8606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-216-5118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "WILLIAM",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DNP, RN, APN, AGACNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-26",
        "last_updated": "2018-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IL",
            "license": "209.017727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Breanna Elizabeth-Howe Kellogg
• Elizabeth M Kelly, MSN
• Lance Kelly, MD
• Morgan Kelly
• Patrick Donovan Kelly, D.D.S.
• Jake Clifton Kelow III, LSW/CADC/ATE/COPD I
• Hannah Kempker, PHARMD
• Reece Calvin Kendall, MD
• Caleb Keng
• Kathleen Kennedy

• Acute Care Nurse Practitioner in Maywood, IL
• Providers in Maywood, IL by specialty
• Acute Care Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.