Kelly Jean Kalmer, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

209013852 Issued in IL

Practice address

9401 Holy Cross LN Ste 112
Breese, IL 62230-3510

Phone

(618) 206-2082

NPI assigned

Feb 22, 2016

Last updated

Feb 15, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1456099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550188800000",
    "number": "1356700173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9401 HOLY CROSS LN STE 112",
            "city": "BREESE",
            "state": "IL",
            "postal_code": "622303510",
            "telephone_number": "618-206-2082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9401 HOLY CROSS LN STE 112",
            "city": "BREESE",
            "state": "IL",
            "postal_code": "622303510",
            "telephone_number": "618-206-2082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALMER",
        "first_name": "KELLY",
        "middle_name": "JEAN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-22",
        "last_updated": "2019-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209013852",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IL",
            "license": "209013852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Illinois Family Pharmacy LLC (Comprehensive Care Pharmacy)
• Illinois Family Pharmacy LLC (Comprehensive Care Pharmacy - Long Term Care)
• Infinity-Meds LLP
• Travis Allen Isaak, D.C.
• Clarece Rose Jansen
• Alyssa M Kampwerth, PHARM.D.
• David Louis Kee, DPM
• Renee Keller, LCSW
• Jennifer Jo Klostermann, MS, CCC-SLP
• Katy Marie Knolhoff

• Gerontology Nurse Practitioner in Breese, IL
• Providers in Breese, IL by specialty
• Gerontology Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.