Basic Information
| Provider Information | |||||||||
| NPI: | 1245758580 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHUMATE | ||||||||
| FirstName: | COREY | ||||||||
| MiddleName: | WENDELL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | APN, PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 W 68TH ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606291882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738847640 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2701 W 68TH ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738849000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2017 | ||||||||
| LastUpdateDate: | 07/09/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 209.016033 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.