Active NPI
Kaitlyn Bockelman, PA-C
- Physician Assistant
- Peoria, IL
National Provider Identifier
1700799822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085.012542
- Practice address
- 221 NE Glen Oak Ave
Peoria, IL 61636-1000 - Phone
- (309) 672-5522
- NPI assigned
- Sep 28, 2026
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085.012542 | IL | Primary |
Addresses
Primary practice location
221 NE Glen Oak Ave
Peoria, IL 61636-1000
Mailing address
1800 Branton CT
Broadview Heights, OH 44147-4409
Phone (440) 724-9045
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1790553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1790553600000",
"number": "1700799822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 BRANTON CT",
"city": "BROADVIEW HEIGHTS",
"state": "OH",
"postal_code": "441474409",
"telephone_number": "440-724-9045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "221 NE GLEN OAK AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616361000",
"telephone_number": "309-672-5522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOCKELMAN",
"first_name": "KAITLYN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-09-28",
"last_updated": "2026-09-28",
"certification_date": "2026-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085.012542",
"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 Sep 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.