Individual provider Active NPI

McKenzie Leigh Nikonovich, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Maryville, IL
National Provider Identifier
1518810852
Registry record updated Feb 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
209.034755 Issued in IL
Practice address
6805 State Route 162 Ste 201
Maryville, IL 62062-8530
Phone
(618) 288-5019
NPI assigned
Feb 17, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 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 209.034755 IL Primary

Addresses

Primary practice location

6805 State Route 162 Ste 201
Maryville, IL 62062-8530

Mailing address

6805 State Route 162 Ste 201
Maryville, IL 62062-8530
Phone (618) 288-5019

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
I20260313000271 IL Practitioner - Nurse Practitioner 3072096411 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Illinois Associates LLCGroup PAC ID 2961489992, 16 clinicians

Practice addresses (Care Compare)

6805 State Route 162
Suite 201
Maryville, IL 62062-8530
Phone (618) 288-5019

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209.034755ILMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Illinois Associates LLC CurrentSince Feb 27, 2026 Accepting new patients
Psychiatric Urgent Care LLC CurrentSince Feb 27, 2026 Accepting new patients

Locations

6805 Highway 162
#201
Maryville, IL 62062
Phone (618) 288-5019

6805 State Route 162
#201
Maryville, IL 62062
Phone (618) 288-5019

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/17590/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir4.healow.com/fhir/r4/AFHDDD

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": "1771286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771286400000",
    "number": "1518810852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6805 STATE ROUTE 162 STE 201",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628530",
            "telephone_number": "618-288-5019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6805 STATE ROUTE 162 STE 201",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628530",
            "telephone_number": "618-288-5019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIKONOVICH",
        "first_name": "MCKENZIE",
        "middle_name": "LEIGH",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-02-17",
        "last_updated": "2026-02-17",
        "certification_date": "2026-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209.034755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, IL

Sources for this page

Verify at the official NPI Registry.