Healthcare Provider Details

I. General information

NPI: 1881387660
Provider Name (Legal Business Name): RILEY RENEE CLUBB BSN, RN, DNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RILEY RENEE SPICKERMAN BSN, RN

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 SAINT FRANCIS WAY
LITCHFIELD IL
62056-1779
US

IV. Provider business mailing address

109 E MAPLE ST
GILLESPIE IL
62033-1473
US

V. Phone/Fax

Practice location:
  • Phone: 217-250-2380
  • Fax:
Mailing address:
  • Phone: 217-839-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209029835
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.454256
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: