Active NPI
Kim Maria Shay
- Family Nurse Practitioner
- Peoria, IL
National Provider Identifier
1891090312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 209.008069
- Practice address
- 1201 N North St
Peoria, IL 61606-1533 - Phone
- (309) 671-2310
- Fax
- (309) 674-3560
- NPI assigned
- Jan 13, 2011
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209.008069 | IL | Primary |
Addresses
Primary practice location
1201 N North St
Peoria, IL 61606-1533
Mailing address
1201 N North St
Peoria, IL 61606-1533
Phone (309) 671-2310
Other names 1
- Kim Maria Garrett
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209.008069 | IL | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1294876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1483920000000",
"number": "1891090312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 N NORTH ST",
"city": "PEORIA",
"state": "IL",
"postal_code": "616061533",
"telephone_number": "309-671-2310",
"fax_number": "309-674-3560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 N NORTH ST",
"city": "PEORIA",
"state": "IL",
"postal_code": "616061533",
"telephone_number": "309-671-2310",
"fax_number": "309-674-3560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAY",
"first_name": "KIM",
"middle_name": "MARIA",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-01-13",
"last_updated": "2017-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IL",
"license": "209.008069",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KIM",
"last_name": "GARRETT",
"middle_name": "MARIA",
"credential": "NURSE PRACTITIONER",
"code": "1",
"type": "Former Name"
}
]
}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 Jan 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.