BRAEDON HAERTLING (NPI# 1689223729) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| 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 |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 085007253 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | PHYSICIAN ASSISTANT LICENSE | 085007253 | 01 |
| Street Address |
4121 VETERANS MEMORIAL DR |
| City | MOUNT VERNON |
| State | IL |
| Zip Code | 62864-6262 |
| 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 | ||||
| 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 Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| 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. |
| 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 | ||||
| City | MOUNT VERNON |
| Zip Code | 62864 |
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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.