Kendra Mickelson
Individual provider Active NPI Skilled Nursing Facility · Eureka, IL
NPI 1992158356 · NPPES record last updated Jul 20, 2016
Key facts
- NPI
- 1992158356
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 0042424 (IL)
- Practice address
- 700 N Main St
Eureka, IL 61530-1085 - Phone
- (309) 467-9094
- Fax
- (309) 467-9011
- NPI assigned
- Jul 20, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0042424 | IL | MD | Skilled Nursing Facility |
| 1694647 | IL | MD | Skilled Nursing Facility |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maple Lawn Health Center | Skilled Nursing Facility | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 0042424 | IL | Yes |
| Skilled Nursing Facility | 314000000X | 1694647 | IL |
Addresses
Primary practice location
700 N Main St
Eureka, IL 61530-1085
Mailing address
700 N Main St
Eureka, IL 61530-1085
Phone (309) 467-9094
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0042424 | Medicaid | IL | |
| 314000000X | Other | IL | TAXONOMY NUMBER |
Other providers in Eureka, IL
- Monica Malcome
- Maple Lawn Health Center
- Maple Lawn Homes Inc.
- Joy Martin
- Michael S Borzello DDS LTD
- Alexa Miller
- David L. Miller
- Modern Movement PLLC
- Laura Jo Morrow
- Daniel R Mueller
All providers in Eureka, IL · Skilled Nursing Facility in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.