Provider Demographics
NPI:1548945074
Name:BARNES, NICOLE TAYLOR (AGPCNP-C)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:TAYLOR
Last Name:BARNES
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:TAYLOR
Other - Last Name:GREGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGPCNP-C
Mailing Address - Street 1:8600 IL-91 STE 130
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615
Mailing Address - Country:US
Mailing Address - Phone:309-683-5050
Mailing Address - Fax:
Practice Address - Street 1:8600 IL-91
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615
Practice Address - Country:US
Practice Address - Phone:309-683-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209027435363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health