STEPHANIE KELLY (FNP-C) – Family Nurse Practitioner, NPI 1770240897

STEPHANIE KELLY (FNP-C) is a healthcare provider. based in Fairview heights, Illinois. specializing in NURSE PRACTITIONER. They hold the professional credentials FNP-C. They hold a License No. 209.020881 (IL). The NPI Number for STEPHANIE KELLY (FNP-C) is 1770240897

Main info

Female
7 Years Of Experience
Accepts Medicare Assignment
Name
STEPHANIE KELLY (FNP-C)
NPI
1770240897
Phone
(618) 239-0678
Address
5023 N ILLINOIS ST
Enumeration Date
23 November 2021
Last Update Date
23 November 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6182390678
Graduation Year
2019 (7 years ago)
PAC ID
4486046489
Group Practice PAC ID
3678549268
Professional Enrollment ID
I20220125002677
Address ID
IL622083453FA5023XSTXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience32
Completeness75
Years active:4State licenses:1Digital endpointsOther names

11,632 NURSE PRACTITIONER in IL

Provider Addresses for STEPHANIE KELLY (FNP-C)

  • 5023 N ILLINOIS ST

    FAIRVIEW HEIGHTS, IL 622083453

    Phone: (618) 239-0678

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 51 Open Payments records for all available years, with a total value of $1,057.

Total Amount is formed as General ($1,057) + Research ($0) + Ownership ($0) = $1,057.

Last reported payment date: 2024-12-10 • Largest payer in this snapshot: ABBVIE INC. ($211).

Total Amount

$1,057

General + Research + Ownership

Payments

51

Total payment records

General Amount

$1,057

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-10

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2022-01-25

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20220125002677INurse PractitionerILTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 62208)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 3678549268View full group profile
NameSpecialtyState
-AZ
-MO
Physician AssistantIL
G A S T R O E N T E R O L O G YIL
P A T H O L O G YIL

Reviews

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Frequently asked questions

Is STEPHANIE KELLY (FNP-C) listed with a National Provider Identifier?
Yes — STEPHANIE KELLY (FNP-C) has NPI 1770240897 on file in the registry.
Is STEPHANIE KELLY (FNP-C) still an active registrant?
STEPHANIE KELLY (FNP-C) carries an active NPI according to the public dataset.
How would a patient describe STEPHANIE KELLY (FNP-C)'s focus?
For STEPHANIE KELLY (FNP-C), the primary taxonomy reads as Family Nurse Practitioner. Clinical services aligned with this taxonomy classification.
What locale is associated with STEPHANIE KELLY (FNP-C)?
Directory geography for STEPHANIE KELLY (FNP-C) centers on Fairview Heights, Illinois.
When was this NPI issued?
Enumeration for STEPHANIE KELLY (FNP-C) is noted as November 23, 2021 where the registry provides it.

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