Kathy A Willenborg, RN, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

209016361 Issued in IL

Practice address

1000 N Main St
Anna, IL 62906-1652

Phone

(618) 202-6441

NPI assigned

Jul 20, 2011

Sex

Female

Sole proprietor

No

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 MO

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, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bootheel Counseling ServicesGroup PAC ID 5496725145, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

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.

• Bootheel Counseling Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Sikeston, MO
  • NPI 1386789139
  Medicare reassignment Care Compare group NPD
• Cape Girardeau Behavioral Health LLC

  • Psychiatric Hospital
  • Cape Girardeau, MO
  • NPI 1700485281

  Psychiatric/Mental Health

  Medicare reassignment NPD
• Bootheel Counseling Services

  • Rural Health Clinic/Center
  • Sikeston, MO
  • NPI 1497064547
  NPD
• Bootheel Counseling Services

  • Community/Behavioral Health Agency
  • Sikeston, MO
  • NPI 1700652898
  NPD (past)
• Children'S Home of Jefferson County

  • Community/Behavioral Health Agency
  • Watertown, NY
  • NPI 1538455696
  NPD (past)

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

{
    "created_epoch": "1311120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664582400000",
    "number": "1760770085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N MAIN ST",
            "city": "ANNA",
            "state": "IL",
            "postal_code": "629061652",
            "telephone_number": "618-202-6441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N MAIN ST",
            "city": "ANNA",
            "state": "IL",
            "postal_code": "629061652",
            "telephone_number": "618-202-6441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLENBORG",
        "first_name": "KATHY",
        "middle_name": "A",
        "credential": "RN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-20",
        "last_updated": "2022-10-01",
        "certification_date": "2022-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209016361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark J. Wells, D.D.S.
• Elizabeth Wheeler, OTR
• Kathryn Whiteside, OTR
• Nichole Whitworth, LPN
• Holly A Wilke, CRNA
• Marla Williams
• Karly Mae Williard
• Jessica Elizabeth Wills, NP
• Meredith Woods, LCSW
• Yates Emergency Physicians

• Psychiatric/Mental Health Nurse Practitioner in Anna, IL
• Providers in Anna, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2022; 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.