Healthcare Provider Details

I. General information

NPI: 1538702477
Provider Name (Legal Business Name): SARAH BETH SKILES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E GRANT ST STE 213
MACOMB IL
61455-3378
US

IV. Provider business mailing address

520 E JEFFERSON ST
MACOMB IL
61455-2316
US

V. Phone/Fax

Practice location:
  • Phone: 309-837-6937
  • Fax:
Mailing address:
  • Phone: 309-221-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041403044
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209020204
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: