Healthcare Provider Details

I. General information

NPI: 1386562114
Provider Name (Legal Business Name): ARIANNA VICTORIA BRACEY APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 N 11TH ST
QUINCY IL
62301-2662
US

IV. Provider business mailing address

15213 WOODMANN CIR
CANTON MO
63435-3456
US

V. Phone/Fax

Practice location:
  • Phone: 217-224-9484
  • Fax:
Mailing address:
  • Phone: 217-440-4234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number209.036020
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: