| Mr Angelito Dariel Tacderas, APN | |
|
3331 W Deyoung St, Ste 308, Marion, IL 62959-5896 | |
| (618) 997-1200 | |
| (618) 997-1212 |
| Full Name | Mr Angelito Dariel Tacderas |
|---|---|
| Gender | Male |
| Speciality | Nurse Practitioner |
| Experience | 16 Years |
| Location | 3331 W Deyoung St, Marion, Illinois |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467785014 | NPI | - | NPPES |
| PENDING | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363L00000X | Nurse Practitioner | 209.007762 (Illinois) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Anna Hospital Corporation D/b/a Union County Hospital | Anna, IL | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Kemell Health Llc | 5597189571 | 3 |
| Advanced Kidney Institute, L.l.c. | 5991743262 | 2 |
| Entity Name | Advanced Kidney Institute, L.l.c. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1932237815 PECOS PAC ID: 5991743262 Enrollment ID: O20050419000430 |
| Entity Name | Kemell Health Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1487274247 PECOS PAC ID: 5597189571 Enrollment ID: O20220511000883 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Angelito Dariel Tacderas, APN Po Box 430, Marion, IL 62959-0430 Ph: (618) 997-1200 | Mr Angelito Dariel Tacderas, APN 3331 W Deyoung St, Ste 308, Marion, IL 62959-5896 Ph: (618) 997-1200 |
Era Louise Mattingly, APN Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 11522 White Pine Ave, Marion, IL 62959 Phone: 618-889-4834 | |
Jessie Nicole Fox, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 2808 Outer Dr, Marion, IL 62959 Phone: 618-993-3817 | |
Ms. Peggy Boyd, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 2808 East Outer Drive, Marion, IL 62959 Phone: 618-993-3817 Fax: 618-993-3908 | |
Donna R Walters, CNM Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3408 Office Park Dr, Marion, IL 62959 Phone: 618-997-5266 Fax: 618-997-5285 | |
Antoinette Marie Miller, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3331 W Deyoung St Ste 301, Marion, IL 62959 Phone: 618-998-7239 Fax: 618-998-4365 | |
Mrs. Holly Ann Gates, NP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3111 Williamson County Pkwy, Marion, IL 62959 Phone: 618-519-9200 Fax: 618-985-9155 | |
Rhonda Raye Heatherly, APN, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 106 S Vicksburg St, Marion, IL 62959 Phone: 618-998-1900 |