Healthcare Provider Details

I. General information

NPI: 1396208310
Provider Name (Legal Business Name): CODY BEER APN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 GRIFFIN AVE
PEKIN IL
61554-6246
US

IV. Provider business mailing address

PO BOX 19248
SPRINGFIELD IL
62794-9248
US

V. Phone/Fax

Practice location:
  • Phone: 309-347-4277
  • Fax: 309-347-4388
Mailing address:
  • Phone: 309-347-4277
  • Fax: 309-347-4388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209018970
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: