Brenton Waystout, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209011651 Issued in IL

Practice address

115 E Walnut St
Fairbury, IL 61739

Phone

(815) 692-2305

NPI assigned

Jul 16, 2014

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gibson Community Hospital Association

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

• Mr. Brenton M Kneer Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 17, 2018.

{
    "created_epoch": "1405468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526515200000",
    "number": "1255748745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 E WALNUT ST",
            "city": "FAIRBURY",
            "state": "IL",
            "postal_code": "617391516",
            "telephone_number": "815-692-2305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 E WALNUT ST",
            "city": "FAIRBURY",
            "state": "IL",
            "postal_code": "61739",
            "telephone_number": "815-692-2305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAYSTOUT",
        "first_name": "BRENTON",
        "name_prefix": "Mr.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-16",
        "last_updated": "2018-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209011651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "209011651",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRENTON",
            "last_name": "KNEER",
            "middle_name": "M",
            "prefix": "MR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tracy N Taylor DMD., PC
• Turning Point Therapies Inc
• Kylie Vogel
• Molly Walter, OTR/L
• Rebecca Renae Walz, PA-C
• Rachel Marie Wenger, M.D.
• Colin Wettstein, DPT
• Robert E Worthen, APRN, FNP-BC

• All providers in Fairbury, IL
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; 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.