NPIMap

Organization Active NPI

Central Illinois Friends of Pwa, Inc.

  • Community Health Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1922945542
Registry record updated May 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Nurse PractitionerTaxonomy code 363LC1500X
Legal business name
CENTRAL ILLINOIS FRIENDS OF PWA, INC.
Practice address
2112 E War Memorial Dr
Peoria, IL 61614-8002
Phone
(309) 431-5880
NPI assigned
May 1, 2026
Last updated
May 1, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2026

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

Authorized official

Name
Deric Kimler
Title
Executive Director
Phone
(309) 431-5880

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Clinical Psychologist 103TC0700X NU
Community Health Clinic/Center 261QC1500X NU
Community Health Nurse Practitioner 363LC1500X NU Primary

Addresses

Primary practice location

2112 E War Memorial Dr
Peoria, IL 61614-8002

Mailing address

2112 E War Memorial Dr
Peoria, IL 61614-8002
Phone (309) 431-5880

National Provider Directory

National Provider Directory
Tax ID family
Central Illinois Friends of Pwa Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2112 E War Memorial Dr
Peoria, IL 61614
Phone (309) 431-5880

NPI Registry JSON

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

{
    "created_epoch": "1777593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777593600000",
    "number": "1922945542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2112 E WAR MEMORIAL DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616148002",
            "telephone_number": "309-431-5880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2112 E WAR MEMORIAL DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616148002",
            "telephone_number": "309-431-5880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL ILLINOIS FRIENDS OF PWA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-05-01",
        "last_updated": "2026-05-01",
        "certification_date": "2026-05-01",
        "status": "A",
        "authorized_official_last_name": "KIMLER",
        "authorized_official_first_name": "DERIC",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "309-431-5880"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": "NU",
            "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 May 1, 2026; 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.