DR. TYSON RAND KINNICK (NPI# 1881019925) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881019925 |
| Entity Type | Individual |
| Full Name | DR. TYSON RAND KINNICK |
| Credential | PBT(ASCP), PHD, PA-C |
| Practice Address |
7309 N Knoxville Ave Ste 1 Peoria IL 61614-2086 |
| Practice Telephone | 3096929898 |
| Practice Fax Number | 3096929055 |
| Mailing Telephone | (309) 692-9898 |
| Mailing Fax Number | 3096929055 |
| Enumeration Date | 2014-02-26 |
| Last Update Date | 2017-08-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 085.005762 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 002413 | IA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | ILLINOIS LICENSE NUMBER | 085.005762 | 01 |
| IA | NPI NUMBER | 1881019925 | 01 |
| IA | IOWA LICENSE NUMBER | 002413 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 405 Monroe St, Pella, IA 502191189 | 6416283832 | 6416212333 |
| Street Address |
7309 N KNOXVILLE AVE STE 1 |
| City | PEORIA |
| State | IL |
| Zip Code | 61614-2086 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275057408 | Amber Marian Breitzman | Nurse Practitioner | 7309 N Knoxville Ave Ste 1, Peoria, IL 61614-2086 | 2017-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548818511 | Christine Svoboda | Social Worker | 6919 N Knoxville Ave Ste 100 and 202, Peoria, IL 61614 | 2019-09-03 |
| 1639649007 | Kathy Karouzos Counseling, LLC | Clinic/Center | 330 W. Ivy Ln., Peoria, IL 61614 | 2018-11-28 |
| 1205312790 | Kathleen Marie Hendricks | Nurse Practitioner | 2809 W Willow Knolls Dr, Peoria, IL 61614 | 2018-07-17 |
| 1629563937 | Mary Elizabeth Cunningham | Counselor | 6219 N. Eldorado Dr., Peoria, IL 61614 | 2018-06-28 |
| 1861937955 | Angela Gilles | Social Worker | 6919 N Knoxville Ave Ste 100, Peoria, IL 61614 | 2016-12-27 |
| 1467994897 | Melissa Saxsma | Specialist | 5009 N Executive Dr, Peoria, IL 61614 | 2016-11-16 |
| 1902258874 | Rashid Plastic Surgery, LLC | Plastic Surgery | 804 W Trailcreek Drive, Peoria, IL 61614 | 2016-07-05 |
| 1215313143 | Melissa Lynn Phelan | Nurse Practitioner | 122 E Morningside Dr, Peoria, IL 61614 | 2015-08-03 |
| 1811380165 | All Ways Caring Services, Inc. | In Home Supportive Care | 6919 N Knoxville Ave, Suite 102, Peoria, IL 61614 | 2015-03-11 |
| 1568875920 | Schuler & Arkwell Orthodontic Partnership | Dentist | 2425 Cornerstone Ct. Ste. A, Peoria, IL 61614 | 2014-06-03 |
| Find all providers in zip 61614 | ||||
| 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 |
|---|---|---|---|---|
| 1275148280 | Patricia Miriam Rus | Physician Assistant | 23615 N 105th Dr, Peoria, AZ 85383-1195 | 2020-09-15 |
| 1083235154 | Katlyn Coyer | Physician Assistant | 900 Main St Ste 530, Peoria, IL 61602-1005 | 2020-04-30 |
| 1114586690 | Courtney A Hitpas | Physician Assistant | 3120 N Bigelow St, Peoria, IL 61604-1628 | 2019-06-10 |
| 1689137671 | Jeffrey Benjamin Miessau | Physician Assistant | 7707 N Knoxville Ave Ste 200, Peoria, IL 61614-2020 | 2019-04-08 |
| 1417413337 | Michelle Nemeh | Physician Assistant | 6760 W Thunderbird Rd Ste 100, Peoria, AZ 85381-5048 | 2019-02-15 |
| 1730655572 | Sylwia M. Budzik | Physician Assistant | 8600 Illinois Rt. 91, Suite 300, Peoria, IL 61615 | 2018-10-19 |
| 1962977538 | Ashley Deyoung | Physician Assistant | 13943 N 91st Ave Ste F101, Peoria, AZ 85381-3689 | 2018-10-09 |
| 1326557141 | Melissa L. Kingston | Physician Assistant | 13760 N 93rd Ave Ste 201, Peoria, AZ 85381-4200 | 2017-09-25 |
| 1396196465 | Ayla Diamond | Physician Assistant | 9165 W Thunderbird Rd Ste 200, Peoria, AZ 85381-4847 | 2016-06-29 |
| 1336530948 | Carolina C. Castro | Physician Assistant | 13128 N. 94th Drive, Suite 100, Peoria, AZ 85381-4252 | 2015-02-18 |
| Find all providers in PEORIA | ||||
Please comment or provide details below to improve the information on DR. TYSON RAND KINNICK.
| 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.