Iconic Nurse Network Outreach, Inc

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Legal business name

ICONIC NURSE NETWORK OUTREACH, INC

Practice address

730 N Church St # LL-3
Rockford, IL 61103-6917

Phone

(312) 931-7376

NPI assigned

Jun 13, 2024

Organization subpart

No

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

Authorized official

Name

Miss Lakhila Tellis, RN, CHW

Title

Founder/President

Phone

(312) 468-8604

Specialties & licenses 5

Addresses

Other names 1

• Iconic Health Academy Doing business as

Locations

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

{
    "created_epoch": "1718236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718236800000",
    "number": "1669215141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 N CHURCH ST # LL-3",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611036917",
            "telephone_number": "312-931-7376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 N CHURCH ST # LL-3",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611036917",
            "telephone_number": "312-931-7376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICONIC NURSE NETWORK OUTREACH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-13",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A",
        "authorized_official_last_name": "TELLIS",
        "authorized_official_first_name": "LAKHILA",
        "authorized_official_title_or_position": "FOUNDER/PRESIDENT",
        "authorized_official_telephone_number": "312-468-8604",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "RN, CHW"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WW0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SC1501X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Community Health/Public Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Iconic Health Academy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community Health Worker in Rockford, IL
• Providers in Rockford, IL by specialty
• Community Health Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; 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.