Provider Demographics
NPI:1982329751
Name:ACKERSON, AARON (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:ACKERSON
Suffix:
Gender:M
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W NORTHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4950
Mailing Address - Country:US
Mailing Address - Phone:815-876-6349
Mailing Address - Fax:
Practice Address - Street 1:209 W NORTHLAND AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4950
Practice Address - Country:US
Practice Address - Phone:815-876-6349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202209977NP-PP363LA2100X
WAAP61290133363LA2100X
IL209025003363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care