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General NPI Number Information
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NPI Number | 1598649071
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Entity Type | Organization
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Legal Business Name | SHANELL'S PSYCHIATRY CARE
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Dates
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Enumeration Date | 08/05/2025
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 4615 CORREL AVE
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City | BARTONVILLE
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State | IL
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Zip | 61607-2618
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Country | US
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Telephone | 833-221-4169
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Fax |
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Provider Business Mailing Address
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Address Line | 8420 N KNOXVILLE AVE STE C
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City | PEORIA
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State | IL
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Zip | 61615-2032
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Country | US
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Telephone | 309-229-0799
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHANELL GLADSON
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Credential |
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Telephone | 309-229-0799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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