Provider Demographics
NPI:1609263417
Name:GOMEZ, BETH (FNP BC PMHNP BC)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:
Credentials:FNP BC PMHNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ONARGA
Mailing Address - State:IL
Mailing Address - Zip Code:60955-1312
Mailing Address - Country:US
Mailing Address - Phone:815-268-4413
Mailing Address - Fax:
Practice Address - Street 1:301 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ONARGA
Practice Address - State:IL
Practice Address - Zip Code:60955-1312
Practice Address - Country:US
Practice Address - Phone:217-278-8669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012705363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health