MRS. JENNIFER ELIZABETH KISTNER (NPI# 1972892313) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972892313 |
| Entity Type | Individual |
| Full Name | MRS. JENNIFER ELIZABETH KISTNER |
| Credential | FNP |
| Practice Address |
203 S Main St Dieterich IL 62424 |
| Mailing Address |
1207 Network Centre Dr Ste 3 Effingham IL 62401-4632 |
| Practice Telephone | 2179255730 |
| Practice Fax Number | 2179255736 |
| Mailing Telephone | 2173472707 |
| Mailing Fax Number | 2173472827 |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2018-12-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 209008758 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | RN LICENSE | 041359392 | 01 |
| IL | NURSE PRACTITIONER LICENSE | 209008758 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 512 N Maple St, Effingham, IL 624012005 | 2173477030 | 2173477049 |
| Street Address |
203 S MAIN ST |
| City | DIETERICH |
| State | IL |
| Zip Code | 62424 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922559897 | Poehlers Pharmacy LLC | Pharmacy | 203 S Main St, Suite A, Dieterich, IL 62424-1128 | 2016-10-17 |
| 1619068061 | Michelle Rae Braddy | Family Medicine | 203 S Main St, Dieterich, IL 62424-1128 | 2006-09-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437600897 | Angela Koester | Occupational Therapy Assistant | 5250 N 100th St, Dieterich, IL 62424 | 2016-10-20 |
| 1568619088 | Mid-illinois Medical Care Associates, LLC | Clinic/Center | 203 S. Main St., Dieterich, IL 62424 | 2008-08-27 |
| 1598873176 | Dieterich Comm Unit 30 | Local Education Agency (LEA) | 205 S. Pine, Dieterich, IL 62424 | 2006-08-25 |
| 1467754622 | Michelle Schnepper | Behavioral Analyst | 308 Prairie Dr, Dieterich, IL 62424-1127 | 2010-11-21 |
| 1750507422 | Stephanie Shadle | Developmental Therapist | 304 Prairie Dr, Dieterich, IL 62424-1127 | 2007-04-18 |
| 1346694841 | Traci Walk | Physical Therapy Assistant | 20379 E 1100th Ave, Dieterich, IL 62424-2114 | 2016-04-20 |
| 1477967925 | Diana Williams | Physical Therapy Assistant | 20234 E 1000th Ave, Dieterich, IL 62424-2142 | 2014-06-12 |
| 1528134608 | Keli J. Dhom | Physical Therapist | 19460 E 1150th Ave, Dieterich, IL 62424-2150 | 2006-11-28 |
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619578523 | Kaitlin Lawson Kalnitz | Nurse Practitioner | 745 Mcclintock Dr Ste 360, Burr Ridge, IL 60527-0875 | 2020-11-06 |
| 1841890290 | Maria Malanych | Nurse Practitioner | 5731 Rosinweed Ln, Naperville, IL 60564-1635 | 2020-10-27 |
| 1639778160 | Roxanna Lee Gunnels | Nurse Practitioner | 1 Bronze Pointe Plaza Suite 1a, Swansea, IL 62226 | 2020-10-26 |
| 1295334811 | Mary Farley | Nurse Practitioner | 7308 Northwood Dr, Wonder Lake, IL 60097-8606 | 2020-10-24 |
| 1164021168 | Stephanie Schuster | Nurse Practitioner | 2665 Prairieview Ln N, Aurora, IL 60502-6343 | 2020-10-21 |
| 1316546641 | Vanessa K Bajaj | Nurse Practitioner | 1123 N Claremont Dr, Palatine, IL 60074-4002 | 2020-10-19 |
| 1003414442 | Gachugu Medical Clinic | Nurse Practitioner | 1 E Ferguson Ave, Wood River, IL 62095-1903 | 2020-10-16 |
| 1477151272 | Yolanda K Bradford | Nurse Practitioner | 2700 S California Ave, Chicago, IL 60608-5108 | 2020-10-14 |
| 1265030019 | Andrea Mclean | Nurse Practitioner | 2500 W Reynolds St # 205, Pontiac, IL 61764-9774 | 2020-10-14 |
| 1558968628 | Timothy Nenoff | Nurse Practitioner | 24722 Lincolnway St, Plainfield, IL 60544-2412 | 2020-10-02 |
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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.