Individual
CARRIE MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
3225 HEDLEY RD, SPRINGFIELD, IL 62711-6248
(217) 726-7300
(217) 726-5989
Mailing address
3225 HEDLEY RD, SPRINGFIELD, IL 62711-6248
(217) 726-7300
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.385417
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209020123
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041.385417
RN LICENSE
IL
Enumeration date
07/08/2019
Last updated
04/26/2024
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