Kendra L Shelby

Primary specialty

Lactation Consultant (Non-RN)Taxonomy code 174N00000X

License

L-82571 Issued in IL

Practice address

1425 Sherborn CT S
Minooka, IL 60447-4569

Phone

(815) 557-6792

NPI assigned

Mar 4, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1646352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646352000000",
    "number": "1831846435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 SHERBORN CT S",
            "city": "MINOOKA",
            "state": "IL",
            "postal_code": "604474569",
            "telephone_number": "815-557-6792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 SHERBORN CT S",
            "city": "MINOOKA",
            "state": "IL",
            "postal_code": "604474569",
            "telephone_number": "815-557-6792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELBY",
        "first_name": "KENDRA",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-04",
        "last_updated": "2022-03-04",
        "certification_date": "2022-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Lactation Consultant, Non-RN",
            "state": "IL",
            "license": "L-82571",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER ID",
            "identifier": "S510-5128-2895",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Lactation Consultant (Non-RN) in Minooka, IL
• Providers in Minooka, IL by specialty
• Lactation Consultant (Non-RN) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2022; 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.