Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dietra Leigh Angelly, FNP-C

Individual provider Family Nurse Practitioner · NPI 1902371313

Dietra Leigh Angelly, FNP-C is a Nurse Practitioner in Marion, Illinois. Qualified in 2018, 8 years ago. Practices with Deaconess Illinois Clinic Inc, an 18-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
8
Licensed in
IL
In the registry since
2018
Specialties on file
2
What do these letters mean?
FNP-C — Family Nurse Practitioner, Certified
A family nurse practitioner certified by the AANP.

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Practice location Address checks out

3411 Professional Park Dr
Marion, IL 62959-6394
Phone: (618) 969-8630
Fax: (618) 993-1421
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 209018044 (IL)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 209018044 (IL)

Record details

NPI number1902371313
Entity typeIndividual (Type 1)
GenderFemale
Credentials FNP-C
Sole proprietorYes
NPI enumeratedOctober 11, 2018
Last updated in NPPESApril 8, 2024
Certification dateApril 8, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Deaconess Illinois Clinic Inc — 18 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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