MS. MONIQUE MANDERSON (FNP-C, PMHNP-BC) – Psychiatric/Mental Health Nurse Practitioner, NPI 1619360070
Psychiatric/Mental Health Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MS. MONIQUE MANDERSON (FNP-C, PMHNP-BC)
14 CRABAPPLE LN
GLEN CARBON, IL 620343024
Phone: (618) 801-6677
Type: Mailing
402 S 4TH AVE
YAKIMA, WA 989023546
Phone: (509) 575-4084
Type: Location
122 E MAIN ST STE 124
LAKELAND, FL 338014655
Phone: (708) 205-3517
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: 2023-10-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20160909001608 | I | Nurse Practitioner | IL | TBD |
| I20171122000316 | I | Nurse Practitioner | MO | TBD |
| I20231002002756 | I | Nurse Practitioner | WA | TBD |
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.
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 62034)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | AZ | |
| Physician Assistant | IL | |
| Nurse Practitioner | AZ | |
| Family Practice | AZ | |
| Family Practice, Geriatric Medicine | AZ | |
| Registered Dietitian Or Nutrition Professional | AZ | |
| Internal Medicine | AZ | |
| Nurse Practitioner | IL | |
| - | AZ | |
| Physician Assistant | NY |
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