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

Mary K Kiesewetter, PMHNP

Individual provider Nurse Practitioner · NPI 1114563640

Mary K Kiesewetter, PMHNP is a Nurse Practitioner in Champaign, Illinois. Qualified in 2019, 7 years ago. Practices with Carle Health Care Incorporated, a 1,543-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Illinois.

Years since qualifying
7
Licensed in
IL
In the registry since
2019
Specialties on file
2
What do these letters mean?
PMHNP — Psychiatric-Mental Health Nurse Practitioner
A nurse practitioner specialising in mental health, able to prescribe psychiatric medication.

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Practice location Address checks out

1802 S Mattis Ave
Champaign, IL 61821-5923
Phone: (217) 365-2855
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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 209020494 (IL)
Psychiatric/Mental Health Nurse Practitioner Taxonomy 363LP0808X · Licence 209.020494 (IL)

Record details

NPI number1114563640
Entity typeIndividual (Type 1)
GenderFemale
Credentials PMHNP
Sole proprietorNo
NPI enumeratedNovember 19, 2019
Last updated in NPPESNovember 21, 2019

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Carle Health Care Incorporated — 1543 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

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