MR. PAUL S HAVRILKA III (NPI# 1801071543) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801071543 |
| Entity Type | Individual |
| Full Name | MR. PAUL S HAVRILKA III |
| Credential | APRN, FNP-C |
| Practice Address |
208 E 3rd St Centralia IL 62801-3902 |
| Mailing Address |
8 Cusumano Professional Plaza Dr Mount Vernon IL 62864-6736 |
| Practice Telephone | 6182444800 |
| Practice Fax Number | 6185323128 |
| Mailing Telephone | 6182444800 |
| Mailing Fax Number | 6185323128 |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2020-10-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 041-339986 | IL | Nursing Service Providers |
| N | 163W00000X | Registered Nurse | 2004031849 | MO | Nursing Service Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
121502 | AK | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
209-010-715 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 1134582018 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1003 E Mccord St, Centralia, IL 628013345 | 6184366633 | |
| 104 E Market St, Mc Leansboro, IL 628591317 | 6182444800 | 6185323128 |
| 211 S Perrine Ave, Centralia, IL 628013635 | 6182146969 | |
| 602 S 42nd St, Mount Vernon, IL 628646264 | 6188993278 |
| Street Address |
208 E 3RD ST |
| City | CENTRALIA |
| State | IL |
| Zip Code | 62801-3902 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518102300 | Dr Mark C Hurst Optometrist Ltd | Optometrist | 208 E 3rd St, Centralia, IL 62801-3902 | 2008-12-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356996151 | Matthew Crawford | Counselor | 904 E Martin Luther King Dr, Centralia, IL 62801 | 2019-08-08 |
| 1588130314 | Kennah White | Counselor | 904 E. Mlk Drive, Centralia, IL 62801 | 2018-10-19 |
| 1245721588 | Lindsey Nicole Fogliasso | Counselor | 904 East Mlk Dr., Centralia, IL 62801 | 2018-05-22 |
| 1629573365 | Prabhat Shrestha | Student in an Organized Health Care Education/Training Program | 605 Sable Drive, Centralia, IL 62801 | 2018-03-26 |
| 1619496098 | Whitney Rathmann | Speech-Language Pathologist | 224 South Locust, Centralia, IL 62801 | 2017-09-17 |
| 1376082685 | Athena A Smith | Counselor | 904 E. Martin Luther King Dr, Centralia, IL 62801 | 2017-02-20 |
| 1447704069 | Meghan Branch | Counselor | 904 Martin Luther King Dr, Centralia, IL 62801 | 2016-08-11 |
| 1568820637 | Midland Area Agency On Aging | Case Management | 434 S Poplar Street, Centralia, IL 62801 | 2016-02-04 |
| 1104201714 | Keri Douglas | Nurse Practitioner | 1054 M. L. King Drive #125, Centrailia, IL 62801 | 2015-07-24 |
| 1215331509 | Melissa Dane | Counselor | 904 E Martin Luther King Dr., Centralia, IL 62801 | 2014-10-15 |
| Find all providers in zip 62801 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720575806 | Leslie Williams Apn LLC | Nurse Practitioner | 1007 Martin Luther King Dr, Centralia, IL 62801-3001 | 2018-04-16 |
| 1225583669 | Laurie Dalton | Nurse Practitioner | 1224 Green Street Rd, Centralia, IL 62801-8306 | 2016-08-15 |
| 1962647149 | Leslie Ann Williams | Nurse Practitioner | 203 E 3rd St Ste 2, Centralia, IL 62801-3901 | 2008-12-02 |
| 1821134115 | Agnes Boehning | Nurse Practitioner | 819 E Mccord St, Centralia, IL 62801-3044 | 2007-01-30 |
| 1003433723 | Dale D Pearce | Nurse Practitioner | 1535 W Mccord St, Centralia, IL 62801-5805 | 2020-06-29 |
| 1538649967 | Dana Leigh Trame | Nurse Practitioner | 400 N Pleasant Ave, Centralia, IL 62801-3056 | 2018-08-15 |
| 1487132387 | Brandy Harrison | Nurse Practitioner | 400 N Pleasant Ave, Centralia, IL 62801-3056 | 2018-08-02 |
| 1316454085 | Jessica Lynn Chapman | Nurse Practitioner | 1535 W Mccord St, Centralia, IL 62801-5805 | 2018-01-04 |
| 1861911026 | Alicia Ann Yaeger | Nurse Practitioner | 1601 Medlin Rd, Centralia, IL 62801-9531 | 2017-09-19 |
| 1588105654 | Jana Tull | Nurse Practitioner | 400 N Pleasant Ave, Centralia, IL 62801-3056 | 2017-03-09 |
| Find all providers in CENTRALIA | ||||
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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.