Healthcare Provider Details

I. General information

NPI: 1407198476
Provider Name (Legal Business Name): TASHA RICKERMANN VALLEE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TASHA D. RICKERMANN FNP-BC

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 JEFFERSON ST
QUINCY IL
62301-5652
US

IV. Provider business mailing address

1915 JEFFERSON ST
QUINCY IL
62301-5652
US

V. Phone/Fax

Practice location:
  • Phone: 217-577-2992
  • Fax: 217-214-6785
Mailing address:
  • Phone: 217-577-2992
  • Fax: 217-214-6785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2006019144
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2013006672
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209010408
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277001714
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: