Provider Demographics
NPI:1023349230
Name:MCGINNIS, BECKY L (APN, CNP)
Entity type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:L
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:APN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19248
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9248
Mailing Address - Country:US
Mailing Address - Phone:217-528-7541
Mailing Address - Fax:
Practice Address - Street 1:206 N PEARL ST
Practice Address - Street 2:
Practice Address - City:TEUTOPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62467-1134
Practice Address - Country:US
Practice Address - Phone:217-857-6481
Practice Address - Fax:217-857-6094
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007990363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209.007990OtherNURSE PRACTIONER LICENSE
IL041.340549OtherRN LICENSE
ILF1109189OtherAANP CERTIFICATION
561920002Medicare PIN
IL041.340549OtherRN LICENSE