KRISTIE TAGGART (NPI# 1700155793) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700155793 |
| Entity Type | Individual |
| Full Name | KRISTIE TAGGART |
| Credential | APN |
| Practice Address |
420 Ne Glen Oak Ave Peoria IL 61603-3105 |
| Practice Telephone | 3096249844 |
| Enumeration Date | 2011-12-20 |
| Last Update Date | 2011-12-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 364SP0200X |
Clinical Nurse Specialist Specialization: Pediatrics |
209.008404041.34 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 1467425322 | 05 |
| Street Address |
420 NE GLEN OAK AVE |
| City | PEORIA |
| State | IL |
| Zip Code | 61603-3105 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427057595 | David P Chan | Pediatrics | 420 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2005-07-20 |
| 1164062196 | Tiara J Mullen | Nurse Practitioner | 420 Ne Glen Oak Ave, Peoria, IL 61603-3106 | 2020-01-07 |
| 1700308996 | Amanda Matthews | Nurse Practitioner | 420 Ne Glen Oak Ave, Peoria, IL 61603 | 2017-07-10 |
| 1871026450 | Shari S Mulvey | Pediatrics | 420 Ne Glen Oak Ave, Peoria, IL 61603-3105 | 2017-04-10 |
| 1003268897 | Sandra L. Peach | Nurse Practitioner | 420 Ne Glen Oak Ave, Peoria, IL 61603-3105 | 2016-07-06 |
| 1083062285 | Heather A Boore | Clinical Nurse Specialist | 420 Ne Glen Oak Ave, Suite 401, Peoria, IL 61603 | 2016-05-27 |
| 1336546969 | Jennifer A. Nelson | Nurse Practitioner | 420 Ne Glen Oak Ave, Suite 201, Peoria, IL 61603-3105 | 2014-11-25 |
| 1003219932 | Linda Schmidgall | Nurse Practitioner | 420 Ne Glen Oak Ave, Suite 200, Peoria, IL 61603-3105 | 2014-10-07 |
| 1164839692 | Gregory Puszkiewicz | Pharmacist | 420 Ne Glen Oak Ave, Peoria, IL 61603-3105 | 2014-07-16 |
| 1396183687 | Diana Warnecke | Nurse Practitioner | 420 Ne Glen Oak Ave, Ste 401, Peoria, IL 61603-3105 | 2013-06-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598362980 | Courtney Klein | Nurse Practitioner | 1306 N. Berkley Ave, Peoria, IL 61603 | 2020-10-08 |
| 1114588217 | Kong Xing Wang | Dentist | 320 East Armstrong Ave, Peoria, IL 61603 | 2019-06-28 |
| 1073015319 | Sara Kristine Rosenbery | Nurse Practitioner | 515 Ne Glen Oak Ave Ste 202, Peoria, IL 61603 | 2018-03-02 |
| 1861860058 | Jennifer Michelle Kelsey | Clinical Nurse Specialist | 420 Ne Glen Oak Avenue, Suite 401, Peoria, IL 61603 | 2015-09-04 |
| 1467859793 | Bonnie Lansing | Counselor | 617 N Gendale Avenue, Behavioral Health Adult Program, Peoria, IL 61603 | 2014-12-02 |
| 1639597172 | Jael K. Mahasi | Counselor | 1800 Ne Perry Avenue, Peoria, IL 61603 | 2014-04-02 |
| 1992054829 | Justin S Ferragut | Radiology | 530 Northeast Glen Oak Avenue, Peoria, IL 61603 | 2012-09-06 |
| 1780952994 | Syed Muhammad Tayyab | Internal Medicine | 828 Ne Glen Oak Ave Apt No208a, Peoria, IL 61603 | 2011-12-02 |
| 1528389079 | St. Francis Medical Center | General Acute Care Hospital | 530 N E Glen Oak Ave, Peoria, IL 61603 | 2010-06-18 |
| 1780810648 | Children's Home Association of Illinois | Voluntary or Charitable | 400 E. Frye, Peoria, IL 61603 | 2009-06-05 |
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| Taxonomy Code | 364SP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Clinical Nurse Specialist |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083062285 | Heather A Boore | Clinical Nurse Specialist | 420 Ne Glen Oak Ave, Suite 401, Peoria, IL 61603 | 2016-05-27 |
| 1790139384 | Jenna Ford | Clinical Nurse Specialist | 200 E Pennsylvania Ave, Peoria, IL 61603-3089 | 2016-04-20 |
| 1669897930 | Kristine Michelle Papis | Clinical Nurse Specialist | 320 E Armstrong Ave, Peoria, IL 61603-3172 | 2014-02-24 |
| 1114348620 | Sarah E Dominique | Clinical Nurse Specialist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2013-12-31 |
| 1396183786 | Amy Zimmerman | Clinical Nurse Specialist | 507 E Armstrong Ave, Peoria, IL 61603-3201 | 2013-06-07 |
| 1144525452 | Suzan Cathleen Shane-gray | Clinical Nurse Specialist | 530 Ne Glen Oak Ave, Pob 113, Peoria, IL 61637-0001 | 2011-01-18 |
| 1902136856 | Maureen Whalen Hofmann | Clinical Nurse Specialist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2009-12-28 |
| 1558393751 | Tara Walker | Clinical Nurse Specialist | 14155 N 83rd Ave, Suite #110, Peoria, AZ 85381-5639 | 2006-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962666123 | Sharon Marie Coyer | Clinical Nurse Specialist | 534 Brownstone Dr, St Charles, IL 60174-2807 | 2008-07-16 |
| 1760646962 | Thelma P. Reed | Clinical Nurse Specialist | 326 .west 64th St., Suite 412, Chicago, IL 60621-1334 | 2008-07-16 |
| 1871711283 | Jeannine Marie Cheatham | Clinical Nurse Specialist | 5841 S Maryland Ave # Mc4064, Room C146, Chicago, IL 60637-1447 | 2007-04-23 |
| 1578649372 | Renee C.b. Manworren | Clinical Nurse Specialist | 225 E. Chicago Avenue, Box 47, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611-2991 | 2006-10-27 |
| 1679594014 | Therese Nancy Coha | Clinical Nurse Specialist | 2300 N Childrens Plz # 63, Chicago, IL 60614-3363 | 2006-07-21 |
| 1164908992 | Megan Hughes | Clinical Nurse Specialist | 1775 W Dempster St, Park Ridge, IL 60068-1143 | 2018-07-16 |
| 1508381161 | Nicholette M Andrews | Clinical Nurse Specialist | 355 E Erie St, Chicago, IL 60611-3167 | 2017-08-04 |
| 1043684533 | Gabriel Campos | Clinical Nurse Specialist | 5841 S Maryland Ave, Chicago, IL 60637-1447 | 2015-11-20 |
| 1376937474 | Rona Tiglao | Clinical Nurse Specialist | 1725 W Harrison St, Suite 710, Chicago, IL 60612-3841 | 2015-03-26 |
| 1992196380 | Kimberly Duback | Clinical Nurse Specialist | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2015-02-06 |
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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.