Provider Demographics
NPI:1326360355
Name:SKIMEHORN, STEPHEN J (FNP)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:SKIMEHORN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TILTON
Mailing Address - State:IL
Mailing Address - Zip Code:61833-7423
Mailing Address - Country:US
Mailing Address - Phone:217-898-8277
Mailing Address - Fax:217-703-1637
Practice Address - Street 1:100 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TILTON
Practice Address - State:IL
Practice Address - Zip Code:61833-7423
Practice Address - Country:US
Practice Address - Phone:217-703-1359
Practice Address - Fax:217-703-1367
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003181B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid
ILF400111345Medicare PIN