Healthcare Provider Details

I. General information

NPI: 1649195587
Provider Name (Legal Business Name): BRITTANY BAUMGARDNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N MAIN ST
ROANOKE IL
61561-7585
US

IV. Provider business mailing address

4830 S MARTIN WEBER RD
GLASFORD IL
61533-9721
US

V. Phone/Fax

Practice location:
  • Phone: 309-923-2661
  • Fax:
Mailing address:
  • Phone: 309-678-8836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.036316
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: