Healthcare Provider Details

I. General information

NPI: 1518216779
Provider Name (Legal Business Name): CAROLINE BARNES APP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINE GILLHOUSE

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8940 N WOOD SAGE RD
PEORIA IL
61615-7822
US

IV. Provider business mailing address

8940 N WOOD SAGE RD
PEORIA IL
61615-7822
US

V. Phone/Fax

Practice location:
  • Phone: 309-243-3000
  • Fax: 309-243-3040
Mailing address:
  • Phone: 309-243-3000
  • Fax: 309-243-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209009782
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209009782
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: