Derek G Kenneaster (NPI# 1457372724, PAC ID# 9133147911) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is DERMATOLOGY.
| Nation Provider ID (NPI) | 1457372724 |
| PAC ID by PECOS | 9133147911 |
| Professional Enrollment ID | I20101124000877 |
| Full Name | Derek G Kenneaster |
| Organization Legal Name | SOUTHERN ILLINOIS DERMATOLOGY, PC |
| Address |
108 N Emma St West Frankfort IL 62896-2443 |
| Phone Number | 6189371346 |
| Gender | M |
| Credential | MD |
| Medical School | SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE |
| Graduation Year | 1993 |
| Primary Specialty | DERMATOLOGY |
| Group Practice PAC ID | 2769479203 |
| Number of Group Practice Members | 11 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 140011 | SOUTHERN ILLINOIS HOSPITAL SERVICES DBA HERRIN HOSPITAL |
| 141324 | FERRELL HOSPITAL COMMUNITY FOUNDATIONS |
| Address | Phone | Organization |
|---|---|---|
| 108 N Emma St, West Frankfort, IL 62896-2443 | 6189371346 | SOUTHERN ILLINOIS DERMATOLOGY, PC |
| Organization Legal Name | SOUTHERN ILLINOIS DERMATOLOGY, PC |
| Physicians | 10 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Stephanie L Natyshok | Physician Assistant | Southern Illinois Dermatology, PC | 108 N Emma St, West Frankfort, IL 62896-2443 |
| Gerri Dyer | Nurse Practitioner | Southern Illinois Dermatology, PC | 220 N Park Ave, Suite 2, Herrin, IL 62948-3150 |
| Christine R Watson | Physician Assistant | Southern Illinois Dermatology, PC | 9515 Holy Cross Ln, Breese, IL 62230-3618 |
| Alexis E Lorinskas | Physician Assistant | Southern Illinois Dermatology, PC | 111 W Main St, Du Quoin, IL 62832-1614 |
| Melody Hof | Physician Assistant | Southern Illinois Dermatology, PC | 111 W Main St, Du Quoin, IL 62832-1614 |
| Misty D Hammond | Nurse Practitioner | Southern Illinois Dermatology, PC | 111 W Main St, Du Quoin, IL 62832-1614 |
| Ted G Van Acker | Dermatology | Southern Illinois Dermatology, PC | 325 Spring St, Red Bud, IL 62278-1105 |
| Shanda C Swagler | Nurse Practitioner | Southern Illinois Dermatology, PC | 100 W Main St, Salem, IL 62881-1500 |
| Natalie D Spiller | Physician Assistant | Southern Illinois Dermatology, PC | 325 Spring St, Red Bud, IL 62278-1105 |
| Street Address |
108 N EMMA ST |
| City | WEST FRANKFORT |
| State | IL |
| Zip | 62896-2443 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Stephanie L Natyshok | Physician Assistant | Southern Illinois Dermatology, PC | 108 N Emma St, West Frankfort, IL 62896-2443 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Robin Dailey | Nurse Practitioner | Southern Illinois Medical Care Associates LLC | 406 W Saint Louis St, West Frankfort, IL 62896-1956 |
| Danneille C Trujillo Hansen | Certified Clinical Nurse Specialist (cns) | 410 W Saint Louis St, West Frankfort, IL 62896-1956 | |
| Julie Adkins | Nurse Practitioner | 406 W Saint Louis St, West Frankfort, IL 62896-1956 | |
| Adam J Henson | Family Medicine | Southern Illinois Medical Services, Nfp | 502 W Saint Louis St, Suite 4, West Frankfort, IL 62896-1968 |
| Christopher S Shadowens | Physician Assistant | Southern Illinois Medical Services, Nfp | 502 W Saint Louis St, Suite 4, West Frankfort, IL 62896-1968 |
| Diana L Tomlianovich | Nurse Practitioner | Southern Illinois Medical Services, Nfp | 502 W Saint Louis St, Suite 4, West Frankfort, IL 62896-1968 |
| Wesley Ray Howell | Physician Assistant | Southern Illinois Medical Services, Nfp | 502 W Saint Louis St, Suite 4, West Frankfort, IL 62896-1968 |
| Meredith Grace Lukens | Physician Assistant | Southern Illinois Medical Services, Nfp | 502 W Saint Louis St, Suite 4, West Frankfort, IL 62896-1968 |
| Elizabeth A Parks | Physician Assistant | Southern Illinois Medical Services, Nfp | 502 W Saint Louis St, Suite 4, West Frankfort, IL 62896-1968 |
| Rachel Lynn Terrill | Physician Assistant | Southern Illinois Medical Services, Nfp | 502 W Saint Louis St, Suite 4, West Frankfort, IL 62896-1968 |
| Find all physicians in zip 62896 | |||
| City | WEST FRANKFORT |
| Zip Code | 62896 |
| Specialty | DERMATOLOGY |
| City + Specialty | WEST FRANKFORT + DERMATOLOGY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.