Dermcare & Healthcare Clinic, LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209009665 Issued in IL

Legal business name

DERMCARE & HEALTHCARE CLINIC, LLC

Practice address

1007 M L King Dr Ste 1
Centralia, IL 62801-3009

Phone

(618) 918-2566

Fax

(618) 918-2565

NPI assigned

Jun 7, 2018

Organization subpart

No

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

Authorized official

Name

Tracy Dawn Arnold, NP-CNPI 1952660300

Title

Owner, NP-C

Phone

(618) 918-2566

Specialties & licenses 1

Addresses

Other names 1

• Dermatology and Medical Clinic, LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tracy Arnold, APNP

  • Nurse Practitioner
  • Centralia, IL
  • NPI 1952660300
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1528329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579651200000",
    "number": "1053804740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 M L KING DR STE 1",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013009",
            "telephone_number": "618-918-2566",
            "fax_number": "618-918-2565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 M L KING DR STE 1",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013009",
            "telephone_number": "618-918-2566",
            "fax_number": "618-918-2565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMCARE & HEALTHCARE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-07",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A",
        "authorized_official_last_name": "ARNOLD",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "OWNER, NP-C",
        "authorized_official_telephone_number": "618-918-2566",
        "authorized_official_credential": "NP-C"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209009665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dermatology and Medical Clinic, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Beth Ann Davison, CNM
• Jared G Deerhake, BS MHP
• Czareenah Dela Cruz Apostol
• Abbey Dempsey
• Xzavier Denton
• Stacey Dinkelman
• Lyndsay Doehring
• Kathy Donnelly
• Patricia Ann Donoho, LMT
• Dr Mark C Hurst Optometrist LTD

• Nurse Practitioner in Centralia, IL
• Providers in Centralia, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; 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.

Verify at the official NPI Registry.