KELSY BRIKAY WASMUTH (NPI# 1336659838) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336659838 |
| Entity Type | Individual |
| Full Name | KELSY BRIKAY WASMUTH |
| Credential | FNP |
| Practice Address |
6810 State Route 162 Ste 100 Maryville IL 62062-8560 |
| Practice Telephone | 6182883616 |
| Practice Fax Number | 6182883647 |
| Mailing Telephone | 6182883616 |
| Mailing Fax Number | 6182883647 |
| Enumeration Date | 2017-10-10 |
| Last Update Date | 2020-02-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
209016647 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | LICENSE | 209016647 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1325 W Whittaker St, Salem, IL 628812007 | 6185483194 | 6185486800 |
| Street Address |
6810 STATE ROUTE 162 STE 100 |
| City | MARYVILLE |
| State | IL |
| Zip Code | 62062-8560 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720055148 | Daniel Steven Johnson | Surgery | 6810 State Route 162 Ste 100, Maryville, IL 62062-8560 | 2006-03-03 |
| 1669609988 | Pei Chang Chung | Surgery | 6810 State Route 162 Ste 100, Maryville, IL 62062-8560 | 2009-06-12 |
| 1093962896 | Richard Henry Wikiera | Surgery | 6810 State Route 162 Ste 100, Maryville, IL 62062-8560 | 2008-08-22 |
| 1164581468 | Charles A. Lane | Surgery | 6810 State Route 162 Ste 100, Maryville, IL 62062-8560 | 2006-12-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104325091 | Jennifer M Oyler | Physician Assistant | 6812 State Route 162 Suite 120, Maryville, IL 62062 | 2018-02-06 |
| 1710495965 | Sarah Elizabeth Barto | Family Medicine | 2133 Vadalabene Drive, Suite Sb, Maryville, IL 62062 | 2018-01-22 |
| 1104348085 | Lindsey Nicole Langendorf | Chiropractor | 62 Executive Plaza Ct, Maryville, IL 62062 | 2017-07-12 |
| 1043750540 | Gina Saal | Nurse Anesthetist, Certified Registered | 6800 Rt 162, Maryville, IL 62062 | 2017-03-02 |
| 1548657737 | Karen Michelle Bertels | Emergency Medicine | 6800 Il - 162, Maryville, IL 62062 | 2015-04-25 |
| 1811258148 | Debra Ann Hoelscher | Internal Medicine | 2102 Vadalabene, Maryville, IL 62062 | 2012-06-04 |
| 1538438445 | Casey Elizabeth Wiesemeyer | Speech-Language Pathologist | 2201 Copper Creek Rd, Maryville, IL 62062 | 2011-12-21 |
| 1407144819 | Norah Claire Farley Baker | Family Medicine | 10 Professional Park Dr., Maryville, IL 62062 | 2011-07-19 |
| 1891092474 | Kimberly M Schneider | Physician Assistant | 20b Professional Park Drive, Maryville, IL 62062 | 2011-02-17 |
| 1669782397 | Purandhri Patel | Physical Therapist | 6820 State Route 162, Maryville, IL 62062 | 2010-10-15 |
| Find all providers in zip 62062 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821600693 | Tonya Ann Bosaw | Nurse Practitioner | 6812 State Route 162 Ste 204, Maryville, IL 62062-8562 | 2020-08-21 |
| 1841815701 | Samantha Mclean | Nurse Practitioner | 2005 Kirkland Blvd, Maryville, TN 37803-3600 | 2020-06-16 |
| 1477102713 | Tammy Ann Buchanon | Nurse Practitioner | 2415 Effler Rd, Maryville, TN 37803-6609 | 2019-09-10 |
| 1316500812 | Caitlyn Michelle Chaires | Nurse Practitioner | 525 W Broadway Ave, Maryville, TN 37801-4782 | 2019-04-19 |
| 1316461460 | Steven Casey Boring | Nurse Practitioner | 907 E. Lamar Alexander Pkwy., Maryville, TN 37804 | 2017-07-31 |
| 1477902708 | Katherine Buckner | Nurse Practitioner | 708 Devictor Dr, Maryville, TN 37801-8666 | 2016-06-07 |
| 1124484415 | Shannon Everett | Nurse Practitioner | 1716 Old Mount Tabor Rd, Maryville, TN 37801-7866 | 2016-01-03 |
| 1952797383 | Amanda Sue Anderson | Nurse Practitioner | 144 Oak Hill Dr, Maryville, IL 62062-6475 | 2015-04-13 |
| 1992194401 | Alyssa R. Loepker | Nurse Practitioner | 6812 State Route 162 Ste 120, Maryville, IL 62062-8586 | 2015-01-21 |
| 1477956076 | Lori B Crisp | Nurse Practitioner | 339 Bmh Physicians Office Bldg, Maryville, TN 37804-5820 | 2014-09-27 |
| Find all providers in MARYVILLE | ||||
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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.