Amanda Catherine Wackt, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209011734 Issued in IL

Practice address

1932 S Main St
Eureka, IL 61530-1666

Phone

(309) 467-5000

NPI assigned

Aug 25, 2014

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Bloomington Pediatrics and Allergy LTD

  • Specialist
  • Bloomington, IL
  • NPI 1053506352
  NPD (past)
• Gibson Community Hospital Association

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)

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

{
    "created_epoch": "1408924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408924800000",
    "number": "1801296108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1932 S MAIN ST",
            "city": "EUREKA",
            "state": "IL",
            "postal_code": "615301666",
            "telephone_number": "309-467-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1932 S MAIN ST",
            "city": "EUREKA",
            "state": "IL",
            "postal_code": "615301666",
            "telephone_number": "309-467-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WACKT",
        "first_name": "AMANDA",
        "middle_name": "CATHERINE",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-25",
        "last_updated": "2014-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209011734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Strong Roots Chiropractic LLC
• Alan Stutzman, PHARMD
• Tazwood Mental Health Center, Inc.
• Malory Rebekah Teegarden, CPM
• The Loft Rehabilitation and Nursing LLC
• Keith William Walder, DC
• Nicholas Weber, DO
• Dee Anne Wettstein, M.D.
• Linda Wood, MS, CCC-SLP/L
• Woodford County

• Family Nurse Practitioner in Eureka, IL
• Providers in Eureka, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.