BRAEDON HAERTLING


Address: 4121 Veterans Memorial Dr, Mount Vernon, IL 62864-6262
Phone: 6182148392

BRAEDON HAERTLING (NPI# 1689223729) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1689223729
Entity Type Individual
Full Name BRAEDON HAERTLING
Credential PA-C
Practice Address 4121 Veterans Memorial Dr
Mount Vernon
IL 62864-6262
Practice Telephone 6182148392
Mailing Telephone 6182148392
Enumeration Date 2019-09-11
Last Update Date 2019-09-11
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363A00000X Physician Assistant 085007253 IL Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
IL PHYSICIAN ASSISTANT LICENSE 085007253 01

Office Location

Street Address 4121 VETERANS MEMORIAL DR
City MOUNT VERNON
State IL
Zip Code 62864-6262

Providers in the same location

NPI Name Taxonomy Address Enumeration
1639146103 Jean Benoit Houle Orthopaedic Surgery 4121 Veterans Memorial Dr, Mount Vernon, IL 62864-6262 2006-03-03
1073147161 Hayden Klockenga Physical Therapist 4121 Veterans Memorial Dr, Mount Vernon, IL 62864-6262 2020-02-27
1669943882 Orthopaedic Center of Southern Illinois, Ltd. Durable Medical Equipment & Medical Supplies 4121 Veterans Memorial Dr, Mount Vernon, IL 62864-6262 2018-12-16
1336680925 Jamie Smith Nurse Practitioner 4121 Veterans Memorial Dr, Mount Vernon, IL 62864-6262 2017-03-15
1629447529 Crystal Tyson Occupational Therapist 4121 Veterans Memorial Dr, Mount Vernon, IL 62864-6262 2015-09-21
1093197410 Melanie Cross Nurse Practitioner 4121 Veterans Memorial Dr, Mount Vernon, IL 62864-6262 2015-06-22
1144600669 Stephanie Schaubert Physical Therapist 4121 Veterans Memorial Dr, Mount Vernon, IL 62864-6262 2015-06-01
1336412527 Scott Murfin Physical Therapist 4121 Veterans Memorial Dr, Mount Vernon, IL 62864-6262 2012-02-17
1144526963 Devin D Haertling Physician Assistant 4121 Veterans Memorial Dr, Mount Vernon, IL 62864-6262 2011-01-27
1366775025 Angela K Oglesby Occupational Therapist 4121 Veterans Memorial Dr, Mount Vernon, IL 62864-6262 2009-09-14
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1619438892 Melissa Pryer Dietitian, Registered 2020 Broadway, Suite 1, Mt. Vernon, IL 62864 2019-03-28
1487145454 Chiropractic Wellness Center of Mt Vernon, LLC. Chiropractor 1009 S 42nd St Ste 5, Mount Vernon, IL 62864 2018-05-24
1851889208 Kimberly Tate Counselor 4110 North Water Place, Mt. Vernon, IL 62864 2018-05-01
1871907790 University Hematology Oncology Inc Specialist #11 Cusumano Professional Plaza, Mount Vernon, IL 62864 2014-06-18
1457771677 Dynamic Counseling and Consultation Services Social Worker 3600 S Water Tower Pl, Mt Vernon, IL 62864 2014-04-27
1619239431 Judith C Morgan Counselor 16338 N Illinois Hwy 37, Mount Vernon, IL 62864 2012-06-08
1073888624 James Brian Verges Counselor 16338 N. Illinois Hwy 37, Mount Vernon, IL 62864 2012-03-15
1720352271 Lucinda M. Holdren Counselor 16338 North Illinois Highway 37, Mount Vernon, IL 62864 2012-03-01
1780978627 Jamie M Orange Physical Therapy Assistant 19958 Fairfield Rd, Mt. Vernon, IL 62864 2011-06-08
1780978791 Wendy Marie Claytor Speech-Language Pathologist 600 E Il Hwy 15, Mount Vernon, IL 62864 2011-06-07
Find all providers in zip 62864

Taxonomy Information

Taxonomy Code 363A00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant

Taxonomy Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1982249124 Leticia B Barrientos Physician Assistant 472 Gramatan Ave Apt Bb4, Mount Vernon, NY 10552-2979 2019-11-12
1396390522 Elizabeth Kuriakose Physician Assistant 203 Gramatan Ave Ste A, Mount Vernon, NY 10550-1291 2019-08-05
1174941728 Lyndsey Switzer Physician Assistant 1600 Continental Pl Ste 101, Mount Vernon, WA 98273-5607 2014-04-01
1255585311 Pamela Welch Physician Assistant 5754 Farm Road 21, Mount Vernon, TX 75457-7749 2008-11-15
1881857787 Telesforo Llamas Jr. Physician Assistant 2 Fisher Dr, Apartment 607, Mount Vernon, NY 10552-3666 2008-07-10
1275712614 Naima R Abdus-salaam Physician Assistant 495 N Fulton Ave, Mount Vernon, NY 10552-1909 2007-11-02
1316006588 Lee Barry Leavelle Physician Assistant 107 W 4th Street, Mount Vernon Neighborhood Health Ctr, Mount Vernon, NY 10550 2006-12-06
1215096359 Patricia Taddeo Physician Assistant 107 West Fourth St, Mount Vernon Neighborhood Health Center, Mount Vernon, NY 10550 2006-12-06
1831270065 Rochelle A, Trussell Physician Assistant 1400 E. Kincaid St, Mount Vernon, WA 98274-4127 2006-10-17
1750497061 Shirley Dallmier Physician Assistant 3307 Broadway St Ste 130, Physician Rural Health Clinic of Jefferson County, Mount Vernon, IL 62864-2387 2006-08-21
Find all providers in MOUNT VERNON

Competitor

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City MOUNT VERNON
Zip Code 62864

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Dataset Information

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.

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