KIMBERLY S FAUKE-HAVENER (NPI# 1891268991) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891268991 |
| Entity Type | Individual |
| Full Name | KIMBERLY S FAUKE-HAVENER |
| Credential | APRN |
| Practice Address |
1770 E Lake Shore Dr Lowr Ll1 Decatur IL 62521-3832 |
| Practice Telephone | 2174641340 |
| Mailing Telephone | 2174641340 |
| Enumeration Date | 2019-01-10 |
| Last Update Date | 2019-01-10 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 209.018538 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1770 E LAKE SHORE DR LOWR LL1 |
| City | DECATUR |
| State | IL |
| Zip Code | 62521-3832 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104835412 | Sherry A Reid | Psychiatry & Neurology | 1770 E Lake Shore Dr Lowr Ll1, Decatur, IL 62521-3832 | 2006-08-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053927988 | Caleb David Braasch | Pharmacist | 1818 South Airport Rd, Decatur, IL 62521 | 2020-09-16 |
| 1295390490 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | Crossing Recovery Center, 495 East Central Ave, Decatur, IL 62521 | 2019-05-03 |
| 1396300638 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 E Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1679138911 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 East Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1154848034 | Zack Shaw | Physical Therapist | 4855-57 East 36, Decatur, IL 62521 | 2017-08-23 |
| 1790032852 | Prashant Morolia | Family Medicine | 4775 E Maryland St, Decatur, IL 62521 | 2012-08-08 |
| 1003188913 | Evergreen Place Decatur, LLC | Assisted Living Facility | 4825 E Evergreen Court, Decatur, IL 62521 | 2012-02-08 |
| 1104133099 | Suzette Marie Shafer | Occupational Therapy Assistant | 1790 S. Fairview Ave., Decatur, IL 62521 | 2010-09-13 |
| 1467784090 | Community Health Improvement Center | Clinic/Center | 1221 East Condit Street, Decatur, IL 62521 | 2010-02-08 |
| 1982839056 | Kelly Clark Dds PC | Dentist | 3737 Us Rt 36 E, Decatur, IL 62521 | 2009-05-19 |
| Find all providers in zip 62521 | ||||
| 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 |
|---|---|---|---|---|
| 1427686062 | Tara Cooley | Nurse Practitioner | 909 Tracey Ln, Decatur, AL 35601-7701 | 2020-03-30 |
| 1407489479 | Marathon Health LLC | Nurse Practitioner | 152 Ipsco St, Decatur, AL 35601-7412 | 2020-02-19 |
| 1518502475 | Marissa Lynne Henderson | Nurse Practitioner | 609 Medical Center Dr Ste 2700, Decatur, TX 76234-3839 | 2019-11-14 |
| 1912463456 | Kimberly S Williams | Nurse Practitioner | 4565 Riverwood Cir, Decatur, GA 30035-2935 | 2019-02-20 |
| 1164907242 | Megan Skelley | Nurse Practitioner | 487 Winn Way Ste 202, Decatur, GA 30030-1728 | 2018-09-25 |
| 1508359969 | Rebecca A Voyles | Nurse Practitioner | 575 W Hay St, Decatur, IL 62526-4164 | 2018-06-11 |
| 1598278558 | Vera Mahou | Nurse Practitioner | 4150 Snapfinger Woods Dr Ste 120, Decatur, GA 30035-3417 | 2017-11-13 |
| 1346753738 | Alexis Renee Graven | Nurse Practitioner | 2300 N Edward St Ste 2400, Decatur, IL 62526-4163 | 2017-11-08 |
| 1508240409 | Zachary Pitts | Nurse Practitioner | 2606 Woodridge Dr, Decatur, GA 30033-4835 | 2015-07-10 |
| 1891063095 | Alexis E. Daugherty | Nurse Practitioner | 603 Church St, Decatur, GA 30030-2517 | 2011-12-02 |
| Find all providers in DECATUR | ||||
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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.