Provider Demographics
NPI:1003514662
Name:DURBIN, JESSICA (APN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DURBIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61753-1422
Mailing Address - Country:US
Mailing Address - Phone:309-660-1059
Mailing Address - Fax:
Practice Address - Street 1:210 SAINT JOSEPH DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3636
Practice Address - Country:US
Practice Address - Phone:309-663-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041461646163W00000X
IL209026873363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse