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

Tedra Ann Lawrence, APRN

Individual provider Nurse Practitioner · NPI 1538988829

Tedra Ann Lawrence, APRN is a Nurse Practitioner in Mount Vernon, Illinois. Qualified in 2024, 2 years ago. Practices with Deaconess Illinois Specialty Clinic, Inc, a 139-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
2
Licensed in
IL
In the registry since
2024
What do these letters mean?
APRN — Advanced Practice Registered Nurse
The umbrella licence covering nurse practitioners, midwives, anaesthetists and clinical nurse specialists.

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Practice location Address checks out

209 Crossroads Pl Ste 120
Mount Vernon, IL 62864-6545
Phone: (618) 918-6045
Fax: (618) 918-6046
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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 209030718 (IL)

Record details

NPI number1538988829
Entity typeIndividual (Type 1)
GenderFemale
Credentials APRN
Sole proprietorNo
NPI enumeratedOctober 4, 2024
Last updated in NPPESDecember 17, 2024
Certification dateDecember 5, 2024
Mailing address209 Crossroads Pl Ste 120, Mount Vernon, IL 62864-6545

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Deaconess Illinois Specialty Clinic, Inc. — 139 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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