Healthcare Provider Details
I. General information
NPI: 1306238860
Provider Name (Legal Business Name): TRISHA FILLIMAN APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 02/20/2015
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1100 BEECH ST BLDG 10-6
NORMAL IL
61761-1568
US
IV. Provider business mailing address
1100 BEECH ST BLDG 10-6
NORMAL IL
61761-1568
US
V. Phone/Fax
- Phone: 309-245-7115
- Fax: 309-204-8259
- Phone: 309-245-7115
- Fax: 309-204-8259
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0808X |
| Taxonomy | Psychiatric/Mental Health Registered Nurse |
| License Number | 041417192 |
| License Number State | IL |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | 277003979 |
| License Number State | IL |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: