Organization Active NPI

NP Women'S Health, PLLC

  • Obstetrics & Gynecology Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1609657980
Registry record updated Oct 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X
Legal business name
NP WOMEN'S HEALTH, PLLC
Practice address
10326 N Juliet CT Ste a
Peoria, IL 61615-1116
Phone
(309) 570-1016
Fax
(309) 570-1017
NPI assigned
Oct 11, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2023

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

Authorized official

Name
Mrs. Sarah Renee Tucker, WHNPNPI 1497140917
Title
Co-Owner
Phone
(309) 840-3008

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LX0001X Primary

Addresses

Primary practice location

10326 N Juliet CT Ste a
Peoria, IL 61615-1116

Mailing address

10326 N Juliet CT Ste a
Peoria, IL 61615-1116
Phone (309) 570-1016

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240224000529 IL Part B Supplier - Clinic/Group Practice 5890130371 Receives reassigned benefits from 2 practitioners
Practice locations: Peoria, IL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2293902NP Women'S Health10326 N Juliet CT - Ste a, Peoria, IL 61615Certificate of waiverNov 15, 2027

National Provider Directory

National Provider Directory

Locations

10326 N Juliet Ct
Ste A
Peoria, IL 61615
Phone (309) 570-1016

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1696982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698451200000",
    "number": "1609657980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10326 N JULIET CT STE A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616151116",
            "telephone_number": "309-570-1016",
            "fax_number": "309-570-1017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10326 N JULIET CT STE A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616151116",
            "telephone_number": "309-570-1016",
            "fax_number": "309-570-1017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NP WOMEN'S HEALTH, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-11",
        "last_updated": "2023-10-28",
        "certification_date": "2023-10-28",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "SARAH",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "309-840-3008",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "WHNP"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.