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

Kandise Rose Marie Mooneyham

Individual provider Family Nurse Practitioner · NPI 1962181115

Kandise Rose Marie Mooneyham is a Nurse Practitioner in Oswego, Illinois. Qualified in 2023, 3 years ago. Practices with Advocate Health and Hospitals Corporation, a 3,079-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
3
Licensed in
IL
In the registry since
2023
Specialties on file
2
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Practice location Address checks out

80 Templeton Dr
Oswego, IL 60543-7000
Phone: (630) 554-3456
Fax: (630) 551-2970
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2365 Monarchos Ln, Montgomery, IL 60538-3439 — (815) 575-5943

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 209028373 (IL)
Registered Nurse Taxonomy 163W00000X · Licence 041452140 (IL)

Record details

NPI number1962181115
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJuly 14, 2023
Last updated in NPPESFebruary 8, 2024
Certification dateFebruary 8, 2024

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Advocate Health And Hospitals Corporation — 3079 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Oswego