Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
NPI 1104230168
Nurse Practitioner in East Saint Louis, IL

Q: What is Board Of Trustees Of Southern Illinois University's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Active since June 18, 2014

601 JAMES R THOMPSON BLVD, BUILDING D, SUITE 2015, EAST SAINT LOUIS, IL 62201(618) 482-6959(618) 482-8311 Get Directions Write a Review

NPPES record last updated: July 15, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 15, 2026, Jun 7, 2026, May 15, 2026 and 3 more (6 updates tracked since 2019).

On this page

About Board Of Trustees Of Southern Illinois University NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY (NPI 1104230168), doing business as Southern Illinois University Edwardsville, is a healthcare organization registered as a nurse practitioner in East Saint Louis, Illinois and active in the NPI registry since June 2014. The organization lists Myjal Garner, Director, as its authorized official.

NPPES Registry Identity

NPI1104230168

Entity TypeOrganization

Primary Taxonomy363L00000X

Legal Business NameBOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY

Location Address601 JAMES R THOMPSON BLVD, BUILDING D, SUITE 2015East Saint Louis, IL 62201-1129

Mailing Address601 James R Thompson Blvd, Building D, Suite 2015East Saint Louis, IL 62201-1129 · (618) 482-6959 · Fax (618) 482-8311

Phone(618) 482-6959

Fax(618) 482-8311

Organization SubpartNo

Authorized OfficialMyjal GarnerDirector · (618) 482-6959

Enumeration DateJune 18, 2014

Last NPPES UpdateJuly 15, 20266 updates tracked since enumeration

NPPES CertifiedJuly 15, 2026

✔ NPI 1104230168 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Also ListedClinic/Center · Multi-SpecialtyTaxonomy 261QM1300X

601 JAMES R THOMPSON BLVD, East Saint Louis, IL 62201

Open in Google Maps ↗

Other Names 1

Doing Business AsSouthern Illinois University Edwardsville

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. VIRGINIA L BEHRHORST BC APRN

Nurse Practitioner (Adult Health)

601 JAMES R THOMPSON BLVD, BUILDING D 2015
EAST SAINT LOUIS, IL 62201

St. Clair County (618) 482-6959

MRS. THERESA M BENASSI-POWLES APN CNP

Nurse Practitioner (Pediatrics)

601 JAMES R THOMPSON BLVD, BUILDING D 2015
EAST SAINT LOUIS, IL 62201

St. Clair County (618) 482-6959

SOUTHERN ILLINOIS UNIVERSITY

Clinic/Center

601 JAMES R THOMPSON BLVD, BUILDING D, SUITE 2015
E SAINT LOUIS, IL 62201

St. Clair County (618) 482-6959

MS. KIM WENONA WHITE CNS-BC

Clinical Nurse Specialist

601 JAMES R THOMPSON BLVD, BUILDING D, SUITE 2015
EAST SAINT LOUIS, IL 62201

St. Clair County (618) 482-6959

MRS. JANET C WHITWORTH RN, FNP-BC, DNP

Nurse Practitioner (Family)

601 JAMES R THOMPSON BLVD, BLDG D 2015
EAST SAINT LOUIS, IL 62201

St. Clair County (618) 482-6959

SOUTHERN ILLINOIS UNIVERSITY EDWARDSVILLE

Clinic/Center (Health Service)

601 JAMES R THOMPSON BLVD, BUILDING D 2015
EAST SAINT LOUIS, IL 62201

St. Clair County (618) 482-6959

CHRISTOPHER WAYNE BARRY LMSW, CRADC

Social Worker

601 JAMES R THOMPSON BLVD
EAST SAINT LOUIS, IL 62201

St. Clair County (618) 482-6959

MS. CHONTAY L MCKAY FNP-C

Nurse Practitioner (Family)

601 JAMES R THOMPSON BLVD, BUILDING D, SUITE 2015
EAST SAINT LOUIS, IL 62201

St. Clair County (618) 482-6959

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Board Of Trustees Of Southern Illinois University's NPI number?

The NPI number for Board Of Trustees Of Southern Illinois University is 1104230168. It was assigned to this organization in the NPPES registry on June 18, 2014. The provider is doing business as Southern Illinois University Edwardsville.

Where is Board Of Trustees Of Southern Illinois University located?

Board Of Trustees Of Southern Illinois University is located at 601 James R Thompson Blvd Building D, Suite 2015, East Saint Louis, IL 62201. The listed phone number is (618) 482-6959.

What is Board Of Trustees Of Southern Illinois University's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

When was this NPI record last updated?

The NPPES record for Board Of Trustees Of Southern Illinois University was last updated on July 15, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 26 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.