Individual provider · NPI-1

Traci Sumer Knierim, NP

Family Medicine · Mattoon, IL

NPI number1407630940
StatusActive
Last updated in NPPESApr 6, 2026

Details

NPI
1407630940
Entity type
Individual (NPI-1)
Name
Traci Sumer Knierim
Credential
NP
Sex
Female
Sole proprietor
Yes
Enumeration date
Aug 24, 2023
Certification date
Apr 6, 2026
Last updated
Apr 6, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine209028007ILYes
363LF0000X Nurse Practitioner, Family209028007IL

Practice location

420 Broadway Ave E
Mattoon, IL 61938-4655

Phone 217-512-1370 · Fax 217-775-0736

Mailing address

420 Broadway Ave E
Mattoon, IL 61938-4655

Phone 217-512-1370 · Fax 217-775-0736

Other practice locations

3115 Village Office Pl
Champaign, IL 61822-7673

Phone 217-531-4101 · Fax 217-954-9290

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