Healthcare Provider Details

I. General information

NPI: 1164393914
Provider Name (Legal Business Name): AMY J STONE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 SPINDER DR
EAST PEORIA IL
61611-0016
US

IV. Provider business mailing address

330 SUNSET BLVD
OGLESBY IL
61348-1166
US

V. Phone/Fax

Practice location:
  • Phone: 309-308-5100
  • Fax:
Mailing address:
  • Phone: 309-308-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209033239
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: