HOLLY DIANE PENNELL (NPI# 1528690799) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528690799 |
| Entity Type | Individual |
| Full Name | HOLLY DIANE PENNELL |
| Credential | NP |
| Practice Address |
1600 W Walnut St Jacksonville IL 62650-1136 |
| Mailing Address |
1332 W State St Jacksonville IL 62650-1849 |
| Practice Telephone | 2172459541 |
| Mailing Telephone | 2173701552 |
| Enumeration Date | 2020-02-06 |
| Last Update Date | 2020-02-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 209.020805 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1600 W WALNUT ST |
| City | JACKSONVILLE |
| State | IL |
| Zip Code | 62650-1136 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609873249 | Charles Milton Sheaff | Surgery | 1600 W Walnut St, East Wing 2nd Floor, Jacksonville, IL 62650-1136 | 2005-06-28 |
| 1669004081 | Elizabeth Ann Johnson | Nurse Practitioner | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2020-02-05 |
| 1164053526 | Kayla Christine Vickers | Physical Therapist | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2020-02-03 |
| 1366912040 | Kelsi Lynn Dobson | Social Worker | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2018-11-26 |
| 1114402518 | Michelle Lee Geiss | Nurse Practitioner | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2018-10-02 |
| 1134606858 | Matthew Pulley | Nurse Practitioner | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2018-07-25 |
| 1760994040 | Passavant Memorial Area Hospital Association | Family Medicine | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2017-10-26 |
| 1871002238 | Courtney Howell | Social Worker | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2017-09-28 |
| 1831639194 | Carrie Elizabeth Janus | Nurse Practitioner | 1600 W Walnut St, The Center for Psychiatric Health, Jacksonville, IL 62650-1136 | 2017-03-06 |
| 1154867539 | Sravanthi Pallapothu | Physical Therapist | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2017-01-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134768708 | Stephanie Lee Mabus | Occupational Therapy Assistant | 873 Gorve St, Jacksonville, IL 62650 | 2019-12-31 |
| 1285281071 | Sharshon Pharmacy Inc | Pharmacy | 154 W Morton Ave, Jacksonville, IL 62650 | 2019-08-26 |
| 1992275499 | Brittany Ruth Helmich | Counselor | 340 W. State St., Jacksonville, IL 62650 | 2018-11-28 |
| 1811391782 | Rodney E. Overstreet | Hearing Instrument Specialist | 1521 W. Walnut, Jacksonville, IL 62650 | 2014-10-21 |
| 1407979818 | Jan Ala | Speech-Language Pathologist | 1111 W Morton, Speechworks, Jacksonville, IL 62650 | 2007-04-09 |
| 1083787592 | Eldon G Barrowes Dds & Assoc PC | Dentist | 1515 West Walnut, Bldg #3, Jacksonville, IL 62650 | 2006-11-15 |
| 1194895979 | Joseph J Kozma | Internal Medicine | 1440 West Walnut, Jacksonville, IL 62650 | 2006-11-08 |
| 1740350529 | Susan Weller | Dentist | 1614 West Lafayette Avenue, Jackson, IL 62650 | 2006-11-08 |
| 1659467793 | Shawn M Fry | Family Medicine | 610 N. Westgate, Jacksonville, IL 62650 | 2006-10-05 |
| 1518050061 | Ward Richard Dunseth II | Nurse Anesthetist, Certified Registered | 1400 W Walnut, Jacksonville, IL 62650 | 2006-10-02 |
| Find all providers in zip 62650 | ||||
| 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 |
|---|---|---|---|---|
| 1639786338 | Bernardo C Lobusta Jr. | Nurse Practitioner | 13500 Sutton Park Dr S Ste 504, Jacksonville, FL 32224-5290 | 2020-09-26 |
| 1720695513 | Kristin Browning | Nurse Practitioner | 1260 Mcduff Ave S # 4, Jacksonville, FL 32205-8030 | 2020-09-25 |
| 1780295667 | Sharnice Letia White | Nurse Practitioner | 11751 Lake Bend Cir, Jacksonville, FL 32218-9057 | 2020-08-13 |
| 1891305082 | Kayla Susan Weller | Nurse Practitioner | 4361 Gadsden Ct, Jacksonville, FL 32207-6218 | 2020-08-03 |
| 1952925315 | Michelle Benefield | Nurse Practitioner | 605 W Beaver St, Jacksonville, FL 32202-4722 | 2020-06-02 |
| 1831739887 | Melanie Bautista | Nurse Practitioner | 4540 Southside Blvd Ste 401, Jacksonville, FL 32216-5488 | 2020-01-07 |
| 1235776279 | Janine Mancusi | Nurse Practitioner | 417 Brody Cove Trl, Jacksonville, FL 32225-5113 | 2019-12-10 |
| 1114576881 | Delesa Gabrielle Bradley | Nurse Practitioner | 1602 S Jackson St, Jacksonville, TX 75766-3028 | 2019-09-05 |
| 1508411190 | Jaclyn Michelle Bowden | Nurse Practitioner | 6930 Bonneval Rd Ste 2, Jacksonville, FL 32216-6084 | 2019-08-09 |
| 1386297414 | Rebecca Newell | Nurse Practitioner | 3151 Blue Heron Dr N, Jacksonville, FL 32223-2706 | 2019-07-17 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 62650 |
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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.