Active NPI
Devine Nutrition Inc
- Clinic/Center
- Palos Hills, IL
National Provider Identifier
1982012241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- License
- 164004722
- Legal business name
- DEVINE NUTRITION INC
- Practice address
- 9000 W College Pkwy
Palos Hills, IL 60465-1444 - Phone
- (708) 608-9014
- Fax
- (708) 304-3801
- NPI assigned
- Jul 30, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Kelly L Devine, MS RD CSSD LDN
- Title
- President
- Phone
- (708) 612-0876
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | 164004722 | IL | Primary |
Addresses
Primary practice location
9000 W College Pkwy
Palos Hills, IL 60465-1444
Mailing address
6521 Charleston St
Oak Forest, IL 60452-2626
Phone (708) 612-0876
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240604002937 | IL | Part B Supplier - Clinic/Group Practice | 7214297936 |
Receives reassigned benefits from 3 practitioners Practice locations: Palos Heights, IL; Tinley Park, IL |
National Provider Directory
National Provider DirectoryLocations
10847 W La Porte Rd
Mokena, IL 60448
7224 W College Dr
Palos Heights, IL 60463
Phone (708) 608-9014
6811 167th St
Ste 6
Tinley Park, IL 60477
Phone (708) 608-9014
Practitioners & affiliated clinicians
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Metabolic Nutrition Registered Dietitian
- Joliet, IL
- NPI 1861883407
-
- Registered Dietitian
- Flossmoor, IL
- NPI 1013316835
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406678400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1773100800000",
"number": "1982012241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6521 CHARLESTON ST",
"city": "OAK FOREST",
"state": "IL",
"postal_code": "604522626",
"telephone_number": "708-612-0876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9000 W COLLEGE PKWY",
"city": "PALOS HILLS",
"state": "IL",
"postal_code": "604651444",
"telephone_number": "708-608-9014",
"fax_number": "708-304-3801"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DEVINE NUTRITION INC",
"organizational_subpart": "NO",
"enumeration_date": "2014-07-30",
"last_updated": "2026-03-10",
"certification_date": "2026-03-10",
"status": "A",
"authorized_official_last_name": "DEVINE",
"authorized_official_first_name": "KELLY",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "708-612-0876",
"authorized_official_name_prefix": "Ms.",
"authorized_official_credential": "MS RD CSSD LDN"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": "IL",
"license": "164004722",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palos Hills, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.