Provider Demographics
NPI:1508569856
Name:BEARD, NICOLE M (APN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:BEARD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:HENDERSON
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:217-588-2600
Mailing Address - Fax:217-862-0202
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:217-862-0202
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209027331363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041.431038OtherRN