Provider Demographics
NPI:1003461831
Name:LEE, JESSICA L (APN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:LEE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:AKERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:1025 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2403
Mailing Address - Country:US
Mailing Address - Phone:217-528-7541
Mailing Address - Fax:
Practice Address - Street 1:350 W CARPENTER ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4902
Practice Address - Country:US
Practice Address - Phone:217-528-7541
Practice Address - Fax:217-528-7144
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019780363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily