Healthcare Provider Details

I. General information

NPI: 1013436039
Provider Name (Legal Business Name): JOELI GEBHART PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOELI DIEMER PA-C

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W OAK ST
CARBONDALE IL
62901-1400
US

IV. Provider business mailing address

PO BOX 19639
SPRINGFIELD IL
62794-9639
US

V. Phone/Fax

Practice location:
  • Phone: 618-536-6621
  • Fax:
Mailing address:
  • Phone: 217-545-3787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-007467
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: