Provider Demographics
NPI:1043760416
Name:TALKINGTON, ASHLEY R (APN-BC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
Last Name:TALKINGTON
Suffix:
Gender:F
Credentials:APN-BC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:R
Other - Last Name:KONNEKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3428
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62708-3428
Mailing Address - Country:US
Mailing Address - Phone:217-588-2624
Mailing Address - Fax:217-757-7550
Practice Address - Street 1:101 E PLUMMER BLVD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-8047
Practice Address - Country:US
Practice Address - Phone:217-588-2600
Practice Address - Fax:217-483-8150
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.399236163WP2201X
IL209.015348363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL376001351008Medicaid
IL376001351007Medicaid