OrganizationActive
Central Illinois Friends of Pwa, Inc.
NPI 1922945542 · Community Health Nurse Practitioner · Peoria, IL
Provider details
- NPI number
- 1922945542
- Entity type
- Organization
- Primary specialty
- Community Health Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Deric Kimler, Executive Director(309) 431-5880
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
- Mental Health Counselor101YM0800X
Behavioral Health & Social Service Providers
- Clinical Psychologist103TC0700X
Behavioral Health & Social Service Providers
- Community Health Clinic/Center261QC1500X
Ambulatory Health Care Facilities
Practice location
2112 E War Memorial Dr
Peoria, IL 61614-8002
Phone: (309) 431-5880
Approximate (ZIP-level) locationGet directions
Mailing address
2112 E War Memorial Dr
Peoria, IL 61614-8002
Registry dates
- Enumerated
- 2026-05-01
- Last updated
- 2026-05-01
- Certified
- 2026-05-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.