Healthcare Provider Details

I. General information

NPI: 1992694988
Provider Name (Legal Business Name): LEAH HEAGY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 N PROSPECT RD
PEORIA IL
61614-4311
US

IV. Provider business mailing address

208 E ELM ST
TREMONT IL
61568-8754
US

V. Phone/Fax

Practice location:
  • Phone: 309-308-5100
  • Fax:
Mailing address:
  • Phone: 309-696-6096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209033331
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: