COURTNEY NICHOLE INNESS – Family Nurse Practitioner, NPI 1073311403

COURTNEY NICHOLE INNESS is a healthcare provider. based in Canton, Illinois. specializing in NURSE PRACTITIONER. They hold a License No. 209.03806 (IL). The NPI Number for COURTNEY NICHOLE INNESS is 1073311403

Main info

Female
2 Years Of Experience
Accepts Medicare Assignment
Name
COURTNEY NICHOLE INNESS
NPI
1073311403
Phone
(309) 647-5240
Address
180 S MAIN ST
Enumeration Date
3 March 2025
Last Update Date
3 March 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3096470201
Graduation Year
2024 (2 years ago)
PAC ID
7618493503
Group Practice PAC ID
2769375021
Professional Enrollment ID
I20250423003009
Address ID
IL614014559GA2028XSTXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience26
Completeness75
Years active:1State licenses:1Digital endpointsOther names

11,637 NURSE PRACTITIONER in IL

Provider Addresses for COURTNEY NICHOLE INNESS

  • 180 S MAIN ST

    CANTON, IL 615202608

    Phone: (309) 647-5240

    Type: Mailing

  • 2028 N SEMINARY ST

    GALESBURG, IL 614014559

    Phone: (309) 647-5240

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-04-23

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250423003009INurse PractitionerILTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 61520)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2769375021View full group profile
NameSpecialtyState
-IL
Emergency MedicineIL
Nurse PractitionerIL
Vascular Surgery, General SurgeryIL
Nurse PractitionerIL
Nurse PractitionerIL
Vascular SurgeryIL
Family PracticeIL
Nurse PractitionerIL
Nurse PractitionerIL

Reviews

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Frequently asked questions

What NPI should I save for COURTNEY NICHOLE INNESS?
Save NPI 1073311403 if you need a stable reference for COURTNEY NICHOLE INNESS.
Is COURTNEY NICHOLE INNESS's enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
Can you summarize COURTNEY NICHOLE INNESS's specialty in plain language?
Clinically, the directory lists COURTNEY NICHOLE INNESS with Family Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Does COURTNEY NICHOLE INNESS practice in Illinois?
You will see Canton, Illinois on file for COURTNEY NICHOLE INNESS alongside any extra practice locations.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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