Individual provider Active NPI

Tiesha Taylor-Ducker, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Champaign, IL
National Provider Identifier
1467312579
Registry record updated Jan 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
2025000570 Issued in IL
Practice address
819 Bloomington Rd
Champaign, IL 61820-2101
Phone
(217) 356-1558
NPI assigned
Nov 12, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 27, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 2025000570 IL Primary

Addresses

Primary practice location

819 Bloomington Rd
Champaign, IL 61820-2101

Mailing address

5616 Colgate LN
Matteson, IL 60443-1509
Phone (217) 356-1558

Other names 1

  • Tiesha Taylor Professional name

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20251229001932 IL Practitioner - Nurse Practitioner 1153817218 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

819 Bloomington Rd
Champaign, IL 61820-2101

9425 Delegates Row
Indianapolis, IN 46240-3805

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2025000570ILMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Promise Healthcare NFP CurrentSince Nov 29, 2025 Accepting new patients
Promise Healthcare NFP CurrentSince Nov 29, 2025 Accepting new patients

Locations

819 Bloomington Rd
Champaign, IL 61820
Phone (217) 356-1558

821 S Neil St
Champaign, IL 61820
Phone (217) 356-1558

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1762905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769472000000",
    "number": "1467312579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5616 COLGATE LN",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604431509",
            "telephone_number": "217-356-1558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 BLOOMINGTON RD",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618202101",
            "telephone_number": "217-356-1558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR-DUCKER",
        "first_name": "TIESHA",
        "name_prefix": "Mrs.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-11-12",
        "last_updated": "2026-01-27",
        "certification_date": "2026-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "2025000570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIESHA",
            "last_name": "TAYLOR",
            "credential": "PMHNP-BC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Champaign, IL

Sources for this page

Verify at the official NPI Registry.