Healthcare Provider Details

I. General information

NPI: 1164905014
Provider Name (Legal Business Name): FELICIA WILLIAMS-TRIPLETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5409 N KNOXVILLE AVE
PEORIA IL
61614-5069
US

IV. Provider business mailing address

5840 W 104TH ST APT 411
OAK LAWN IL
60453-4422
US

V. Phone/Fax

Practice location:
  • Phone: 309-691-1000
  • Fax:
Mailing address:
  • Phone: 708-420-0462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.379038
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209019323
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: