Healthcare Provider Details

I. General information

NPI: 1548004658
Provider Name (Legal Business Name): SHELBY HELMICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 N PROSPECT RD STE A
PEORIA HEIGHTS IL
61616-6570
US

IV. Provider business mailing address

5409 N KNOXVILLE AVE
PEORIA IL
61614-5069
US

V. Phone/Fax

Practice location:
  • Phone: 309-248-6399
  • Fax: 309-248-1001
Mailing address:
  • Phone: 309-691-1069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209029917
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: