Provider Type Icon

DERMCARE & HEALTHCARE CLINIC LLC NPI 1053804740


NPI Information

NPI: 1053804740
Provider Name: DERMCARE & HEALTHCARE CLINIC, LLC

Former Legal Business Name: DERMATOLOGY AND MEDICAL CLINIC, LLC

Classification: Nurse Practitioner - 363L00000X
Entity Type: Organization

CLIA Number: 14D2152525

Address:
1007 M L KING DR STE 1
CENTRALIA, IL
ZIP 62801
Phone: (618) 918-2566
Get Directions

DERMCARE & HEALTHCARE CLINIC, LLC is a nurse practitioner in Centralia, IL. The provider is (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. DERMCARE & HEALTHCARE CLINIC, LLC NPI is 1053804740. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Former Legal Business Name Is Dermatology And Medical Clinic, Llc.

The provider's business location address is:

1007 M L KING DR STE 1
CENTRALIA, IL
ZIP 62801-009
Phone: (618) 918-2566
Fax: (618) 918-2565

The provider's authorized official is Tracy Dawn Arnold .
The authorized official title is Owner, Np-c and has the following contact phone number (618) 918-2566.

The CLIA number assigned to this NPI record is 14D2152525 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/7/2018 and was last updated on 1/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363L00000XNurse Practitioner209009665ILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.