Kelly M Whitaker, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

277.000945 Issued in IL

Practice address

124 W Main St
Mascoutah, IL 62258-2039

Phone

(186) 402-5572

Fax

(636) 333-4510

NPI assigned

Jul 15, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Practice Nursing Services IncGroup PAC ID 4183908999, 2 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Advanced Practice Nursing Services Inc

  • Adult Health Nurse Practitioner
  • Freeburg, IL
  • NPI 1861867863
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1310688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1386932028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 303",
            "city": "MASCOUTAH",
            "state": "IL",
            "postal_code": "622580303",
            "telephone_number": "618-792-3586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 W MAIN ST",
            "city": "MASCOUTAH",
            "state": "IL",
            "postal_code": "622582039",
            "telephone_number": "186-402-5572",
            "fax_number": "636-333-4510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITAKER",
        "first_name": "KELLY",
        "middle_name": "M",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-15",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "277.000945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judith K Weis, M.D.
• Christina Ann Weise, M.S. BCBA
• Abby Wesselmann
• Heidi Jo Westra, DC
• Paige Whipple
• Kristin Nicole Wilmes
• Keioni Wimes, RBT
• Marquita Monique Ann Winston, RBT
• Lisa Woodrome, RPH
• Woods Vision Care Specialists, Inc

• Adult Health Nurse Practitioner in Mascoutah, IL
• Providers in Mascoutah, IL by specialty
• Adult Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.