Healthcare Provider Details

I. General information

NPI: 1790482966
Provider Name (Legal Business Name): DEREK RICE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N ALLEN ST
ROBINSON IL
62454-1114
US

IV. Provider business mailing address

706 N RECTOR AVE
ROBINSON IL
62454-2651
US

V. Phone/Fax

Practice location:
  • Phone: 618-544-3131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209035998
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number041413460
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: