The Little Clinic Illinois

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

THE LITTLE CLINIC ILLINOIS

Practice address

415 S 42ND St
Mount Vernon, IL 62864-6266

Phone

(618) 246-9969

NPI assigned

May 9, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Mary Cay Declue, NP

Title

Owner

Phone

(618) 246-9969

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063461887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 42ND ST",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646266",
            "telephone_number": "618-246-9969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 S 42ND ST",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646266",
            "telephone_number": "618-246-9969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LITTLE CLINIC ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DECLUE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "CAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-246-9969",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• TDL Group, Inc.
• TDL Group, Inc.
• TDL Group, Inc.
• Lucia T Templer, P.T.
• Bruce WM. Thackrey, DMD
• Justine Thole, S.T.
• Thomas H. Nolen, D.P.M., P.C.
• Rachael Leann Thomas, MSN, PMHNP
• Thompson Counseling and Dui Services
• Michael Gregory Thompson, LCPC , CRADC , SAP

• Family Nurse Practitioner in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Family Nurse Practitioner in Illinois

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