Basic Information
| Provider Information | |||||||||
| NPI: | 1649514316 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORSTER | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | KATHLEEN | ||||||||
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| Credential: | CNM, WHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4309 W MEDICAL CENTER DR STE B305 | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600508418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153386600 | ||||||||
| FaxNumber: | 8157594941 | ||||||||
| Practice Location | |||||||||
| Address1: | 4309 W MEDICAL CENTER DR | ||||||||
| Address2: | STE. B310 | ||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153386600 | ||||||||
| FaxNumber: | 8157594666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2012 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WX0003X | 041369474 | IL | N | Nursing Service Providers | Registered Nurse | Obstetric, Inpatient | 367A00000X | 209009824 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 363L00000X | 277001068 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 209010141 | 01 | IL | STATE LICENSE | OTHER |