MS. NICOLE MARIE HARRIS (MSN, PMHNP-BC) – Psychiatric/Mental Health Nurse Practitioner, NPI 1497341994

MS. NICOLE MARIE HARRIS (MSN, PMHNP-BC) is a healthcare provider. based in Bloomington, Illinois. specializing in NURSE PRACTITIONER. They hold the professional credentials MSN, PMHNP-BC. They hold a License No. 209.021964 (IL). The NPI Number for MS. NICOLE MARIE HARRIS (MSN, PMHNP-BC) is 1497341994

Main info

Female
6 Years Of Experience
Accepts Medicare Assignment
Name
MS. NICOLE MARIE HARRIS (MSN, PMHNP-BC)
NPI
1497341994
Phone
(309) 827-4090
Address
207 E HAMILTON RD
Enumeration Date
18 December 2020
Last Update Date
27 July 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3096718000
Graduation Year
2020 (6 years ago)
PAC ID
8123535127
Group Practice PAC ID
6901896968
Professional Enrollment ID
I20250725000255
Address ID
IL616033802PE228XXAVEX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience34
Completeness85
Years active:5State licenses:1Digital endpointsOther names

11,632 NURSE PRACTITIONER in IL

Provider Addresses for MS. NICOLE MARIE HARRIS (MSN, PMHNP-BC)

  • 207 E HAMILTON RD

    BLOOMINGTON, IL 617047527

    Phone: (309) 827-4090

    Type: Mailing

  • 228 NE JEFFERSON AVE

    PEORIA, IL 616033802

    Phone: (309) 671-8000

    Type: Mailing

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: 2025-07-25

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
I20250725000255INurse 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 61704)

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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: 6901896968View full group profile

Reviews

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Frequently asked questions

What federal number belongs to MS. NICOLE MARIE HARRIS (MSN, PMHNP-BC)?
The federal identifier for MS. NICOLE MARIE HARRIS (MSN, PMHNP-BC) is NPI 1497341994.
Is MS. NICOLE MARIE HARRIS (MSN, PMHNP-BC) currently active in the NPI registry?
CMS-published data lists MS. NICOLE MARIE HARRIS (MSN, PMHNP-BC) as an active registrant.
What kind of provider is MS. NICOLE MARIE HARRIS (MSN, PMHNP-BC)?
The page reflects Psychiatric/Mental Health Nurse Practitioner for MS. NICOLE MARIE HARRIS (MSN, PMHNP-BC). Clinical services aligned with this taxonomy classification.
Does MS. NICOLE MARIE HARRIS (MSN, PMHNP-BC) practice in Illinois?
You will see Bloomington, Illinois on file for MS. NICOLE MARIE HARRIS (MSN, PMHNP-BC) 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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