MRS. DENA L MCCORMICK (NPI# 1225066608) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225066608 |
| Entity Type | Individual |
| Full Name | MRS. DENA L MCCORMICK |
| Other Name | DENA L PANKEY |
| Credential | PA-C |
| Practice Address |
201 S 14th St Herrin IL 62948-3631 |
| Mailing Address |
Po Box 3988 Carbondale IL 62902-3988 |
| Practice Telephone | 6189422171 |
| Practice Fax Number | 6189886186 |
| Mailing Telephone | (618) 457-5200 |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
085002236 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE CROSS | 10019630 | 01 |
| IL | 036062597 | 05 | |
| IL | AETNA | 7210895 | 01 |
| IL | BCBS | 3932056 | 01 |
| IL | HAMP | 139759 | 01 |
| IL | HEALTHLINK | 894228 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 405 W Jackson St, Carbondale, IL 629011462 | 6185490721 | 6184570469 |
| 2 S Hospital Dr, Murphysboro, IL 629663333 | 6186843156 | 6185290524 |
| Street Address |
201 S 14TH ST |
| City | HERRIN |
| State | IL |
| Zip Code | 62948-3631 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174524136 | Jeffrey Mark Jacobs | Internal Medicine | 201 S 14th St, Herrin, IL 62948-3631 | 2005-08-02 |
| 1174131015 | Amabelle Estoque | Physical Therapist | 201 S 14th St, Herrin, IL 62948-3631 | 2020-07-16 |
| 1033727938 | Joseph H Painter | Physical Therapist | 201 S 14th St, Herrin, IL 62948-3631 | 2020-07-16 |
| 1134740608 | Ryan Williams | Specialist/Technologist, Other | 201 S 14th St, Herrin, IL 62948-3631 | 2020-05-06 |
| 1548800386 | Danielle Jo Fisher | Nurse Practitioner | 201 S 14th St, Herrin, IL 62948-3631 | 2020-01-09 |
| 1255977062 | Austin Thomas Butler | Specialist/Technologist | 201 S 14th St, Herrin, IL 62948-3631 | 2019-11-27 |
| 1972147213 | Brianna Nicole Krelo | Physical Medicine & Rehabilitation | 201 S 14th St, Herrin, IL 62948-3631 | 2019-10-30 |
| 1942854526 | Janelle Renee Kirby | Nurse Practitioner | 201 S 14th St, Herrin, IL 62948-3631 | 2019-07-31 |
| 1487116901 | Shantell Elizabeth Lodwick | Physical Therapy Assistant | 201 S 14th St, Herrin, IL 62948-3631 | 2019-04-03 |
| 1891257325 | Betsy Putbrese | Physical Therapist | 201 S 14th St, Herrin, IL 62948-3631 | 2019-04-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215307590 | Carmelito Miralles Caronongan | Pediatrics | 120 S. 11th St., Herrin, IL 62948 | 2015-09-30 |
| 1073995684 | Motaz R Wraikat | Preventive Medicine | 315 S 13th St Ste 3, Herrin, IL 62948 | 2015-06-19 |
| 1639427933 | Salim Hosein | Surgery | 317 S 14th St Ste 1, Herrin, IL 62948 | 2012-08-17 |
| 1962780288 | Pooja Sareen | Internal Medicine | 3024 S Park Avenue, Herrin, IL 62948 | 2011-08-03 |
| 1235459918 | Timoteo Castro Md & Josefina D. Castro Md Ltd | Family Medicine | 321 South 13st St., Herrin, IL 62948 | 2010-06-04 |
| 1457501926 | Don Cassidy Arnold II | Urology | 220 S Park Ave Fl 2, Herrin, IL 62948 | 2008-09-22 |
| 1306094560 | Karl Keith Mitchener | Speech-Language Pathologist | 1901 N 13th Street, Herrin, IL 62948 | 2008-08-29 |
| 1457509705 | Kathryn Marie Bordenet-jines | Occupational Therapy Assistant | 1901 N. 13th, Herrin, IL 62948 | 2008-08-28 |
| 1417105776 | Cheryl Lynn Matic | Occupational Therapy Assistant | 1901 N. 13th St., Herrin, IL 62948 | 2008-08-28 |
| 1174771422 | Mary Frances Graham | Physical Therapy Assistant | 1901 N. 13th Street, Herrin, IL 62948 | 2008-08-28 |
| Find all providers in zip 62948 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356892004 | Joshua Smith | Physician Assistant | 201 S 14th St, Herrin, IL 62948-3631 | 2016-10-18 |
| 1992951123 | Logan Primary Care | Physician Assistant | 405 Rushing Dr, Herrin, IL 62948-3730 | 2008-08-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831707298 | Eliza Ballen | Physician Assistant | 335 Sylvan Rd, Lake Bluff, IL 60044-2562 | 2020-07-21 |
| 1477177947 | Rybecca Janovyak | Physician Assistant | 14432 High Rd, Lockport, IL 60441-9402 | 2020-06-01 |
| 1518591759 | Julie Jenkot | Physician Assistant | 333 N Michigan Ave Fl 14, Chicago, IL 60601-3901 | 2020-02-26 |
| 1801429873 | Hinjal D Jha | Physician Assistant | 22285 N Pepper Rd Ste 409, Lake Barrington, IL 60010-2542 | 2020-02-19 |
| 1770120222 | Alvina Shaikh | Physician Assistant | 4009 Warren Ave, Bellwood, IL 60104-2066 | 2019-12-03 |
| 1457997561 | Jasleen Mohini Singh | Physician Assistant | 1645a W School Street, Suite A, Clinic Entrance, Chicago, IL 60657 | 2019-11-24 |
| 1538705272 | Bethany Mae Frisby | Physician Assistant | 8630 W Golf Rd, Niles, IL 60714-5600 | 2019-11-18 |
| 1134761984 | Ella-marie Rakowski | Physician Assistant | 25 Acorn Dr, Hawthorn Woods, IL 60047-7407 | 2019-10-14 |
| 1467001859 | Timothy Omotayo Adesanya | Physician Assistant | Graham Correctional Center, 12078 Illinois Rte 185, Hilliboro, IL 62049 | 2019-09-09 |
| 1518514066 | Victoria Moore | Physician Assistant | 979 W Main St, West Dundee, IL 60118-2088 | 2019-08-20 |
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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.