KACI N HAVLIN (NPI# 1083155311) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083155311 |
| Entity Type | Individual |
| Full Name | KACI N HAVLIN |
| Other Name | KACI N RIDDER |
| Practice Address |
205 S Morse St Roodhouse IL 62082-1322 |
| Mailing Address |
390 Maple Summit Rd Jerseyville IL 62052-2000 |
| Practice Telephone | 2175894383 |
| Practice Fax Number | 2175894409 |
| Mailing Telephone | 6184987518 |
| Mailing Fax Number | 6184983052 |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2019-02-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
209015784 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 523 S Main St, Carrollton, IL 620161256 | 2179423326 | 2179429833 |
| Street Address |
205 S MORSE ST |
| City | ROODHOUSE |
| State | IL |
| Zip Code | 62082-1322 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346676012 | Megan M Skolasinski | Physician Assistant | 205 S Morse St, Roodhouse, IL 62082-1322 | 2013-09-25 |
| 1649484072 | Arlene June Norris | Physician Assistant | 205 S Morse St, Roodhouse, IL 62082-1322 | 2007-05-08 |
| 1437280567 | Julie Christian | Physician Assistant | 205 S Morse St, Roodhouse, IL 62082-1322 | 2007-03-08 |
| 1023143716 | Illini Medical Associates, Sc | Family Medicine | 205 S Morse St, Roodhouse, IL 62082-1322 | 2007-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649826603 | Christina Ann Vanmeter | Nurse Practitioner | 302 E North St, Roodhouse, IL 62082-1129 | 2019-08-15 |
| 1760864334 | Amanda Goben | Developmental Therapist | 457 E North St, Roodhouse, IL 62082-1130 | 2015-06-19 |
| 1023198785 | Pharmacy Plus Inc | Durable Medical Equipment & Medical Supplies | 213 W Clay St, Roodhouse, IL 62082-1344 | 2006-10-17 |
| 1831680057 | Kelsie Harris | Nurse's Aide | 202 W Lorton St, Roodhouse, IL 62082-1514 | 2018-05-23 |
| 1770988735 | Jersey Community Hospital | Clinic/Center | 414 S State St, Roodhouse, IL 62082-1544 | 2014-11-03 |
| 1144313180 | Thomas H. Boyd Memorial Hospital | Clinic/Center | 132 W Lorton St, Roodhouse, IL 62082-1569 | 2006-10-02 |
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649826603 | Christina Ann Vanmeter | Nurse Practitioner | 302 E North St, Roodhouse, IL 62082-1129 | 2019-08-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538760277 | Jennifer Michelle Kennedy | Nurse Practitioner | 3006 Lakeview Dr, Metropolis, IL 62960-3119 | 2020-11-07 |
| 1881295541 | Britney Julia Durst | Nurse Practitioner | 5905 N Prospect Rd, Peoria, IL 61614-4311 | 2020-11-07 |
| 1952902884 | Julia Ann Gottschalk | Nurse Practitioner | 1979 Mcdowell Rd, Unit 103, Naperville, IL 60563 | 2020-11-06 |
| 1932700911 | Laura Ivette Portillo | Nurse Practitioner | 2727 N Marmora Ave, Chicago, IL 60639-1219 | 2020-11-05 |
| 1265033385 | Carolle M Derradji | Nurse Practitioner | 3256 W Potomac Ave, Chicago, IL 60651-2411 | 2020-11-04 |
| 1104427293 | Katie Michelle O'halloran | Nurse Practitioner | 5841 S Maryland Ave # E500, Chicago, IL 60637-1443 | 2020-11-04 |
| 1598365140 | Caitlyn Windsor | Nurse Practitioner | 24525 Grange Rd, Geneseo, IL 61254-8429 | 2020-10-31 |
| 1578163515 | Deanna Bassette | Nurse Practitioner | 243 E 31st St Apt 401, Chicago, IL 60616-5212 | 2020-10-29 |
| 1891395745 | Vrunda Shah Patel | Nurse Practitioner | 933 W Van Buren St Apt 502, Chicago, IL 60607-3583 | 2020-10-29 |
| 1346840337 | Catherine Suh | Nurse Practitioner | 1380 Marcy Ln, Wheeling, IL 60090-4422 | 2020-10-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.