Healthcare Provider Details

I. General information

NPI: 1447143326
Provider Name (Legal Business Name): PAYTON A ROBSON APN-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PAYTON ROBSON APN-CNP

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9697 191ST ST STE 200
MOKENA IL
60448-8617
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 630-646-6540
  • Fax: 630-646-6542
Mailing address:
  • Phone: 847-982-6715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209032173
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209032173
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: