Nurse Practitioner
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Identity confirmed via CMS NPPES · September 30, 2026 · A directory match is not a coverage approval.
Is this your practice? This listing was imported from public provider identity data (CMS NPPES) and has not yet been claimed. Claim this listing to confirm the practice details. Plan acceptance stays unpublished until the practice reports it.
Public record
NPI 1497462964 · enumerated 2022-11-03 · record updated 2023-01-26. Source: CMS NPPES. A listing is not a TRICARE network approval.
NPPES recordGoogle Maps Apple Maps OpenStreetMap
Authorized official: KYLE DILLMAN, Secretary Treasurer · (812) 450-7399
Other names: DEACONESS IL SPECIALTY EXPRESS BROADWAY ST
Addresses and phones
- Practice location 3111 BROADWAY ST, MOUNT VERNON, IL, 62864-2338 (618) 241-0300 Fax (618) 241-0302 Google Maps Apple Maps OpenStreetMap
- Mailing address PO BOX 34266, BELFAST, ME, 04915-0620 (812) 450-6815 Fax (812) 450-6822 Google Maps Apple Maps OpenStreetMap
Specialties
- Family Medicine, Sports Medicine 207QS0010X
- Nurse Practitioner 363L00000X · Primary
In this directory
Locations and evidence
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Practice location
MOUNT VERNON, IL, 628642338
Accepting new patientsNot reportedCMS NPPES · September 30, 2026
Plan acceptance
- No published plan acceptance yet. Confirm directly with the practice, or claim this listing if it's yours.