NPIMap

Organization Active NPI

Central Illinois Friends of Pwa, Inc.

  • Community Health Nurse Practitioner
  • Normal, IL
National Provider Identifier
1982553913
Registry record updated Jan 23, 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
900 Franklin Ave
Normal, IL 61761-4604
Phone
(309) 431-5880
NPI assigned
Jan 23, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LC1500X Primary

Addresses

Primary practice location

900 Franklin Ave
Normal, IL 61761-4604

Mailing address

PO Box 5022
Peoria, IL 61601-5022
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

900 Franklin Ave
Normal, IL 61761
Phone (309) 431-5880

NPI Registry JSON

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

{
    "created_epoch": "1769126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769126400000",
    "number": "1982553913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5022",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616015022",
            "telephone_number": "309-431-5880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 FRANKLIN AVE",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617614604",
            "telephone_number": "309-431-5880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL ILLINOIS FRIENDS OF PWA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-23",
        "last_updated": "2026-01-23",
        "certification_date": "2026-01-23",
        "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": "363LC1500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Normal, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 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.