Active NPI
Monique Takeisha Tillery
- Registered Nurse
- Plymouth Meeting, PA
National Provider Identifier
1326330432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- R164341
- Practice address
- 2250 Hickory Rd Ste 240
Plymouth Meeting, PA 19462-2225 - Phone
- (800) 879-4471
- Fax
- (610) 825-1604
- NPI assigned
- May 8, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R164341 | MD | Primary |
Addresses
Primary practice location
2250 Hickory Rd Ste 240
Plymouth Meeting, PA 19462-2225
Mailing address
4222 Red Haven Rd
Pikesville, MD 21208-5853
Phone (410) 484-7106
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R164341 | Other | MD | RN LICENSE |
Other names 1
- Monique Takeisha Tillery
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R164341 | MD | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304812800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304812800000",
"number": "1326330432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4222 RED HAVEN RD",
"city": "PIKESVILLE",
"state": "MD",
"postal_code": "212085853",
"telephone_number": "410-484-7106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2250 HICKORY RD STE 240",
"city": "PLYMOUTH MEETING",
"state": "PA",
"postal_code": "194622225",
"telephone_number": "800-879-4471",
"fax_number": "610-825-1604"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILLERY",
"first_name": "MONIQUE",
"middle_name": "TAKEISHA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-05-08",
"last_updated": "2011-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MD",
"license": "R164341",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RN LICENSE",
"identifier": "R164341",
"state": "MD"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MONIQUE",
"last_name": "TILLERY",
"middle_name": "TAKEISHA",
"credential": "RN",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Plymouth Meeting, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.