Provider Demographics
NPI:1225571219
Name:HELMS, JACKIE MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:MARIE
Last Name:HELMS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:EL-DARAZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:10628 N HONEYCREEK LN
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:IL
Mailing Address - Zip Code:61525-8738
Mailing Address - Country:US
Mailing Address - Phone:309-678-7705
Mailing Address - Fax:
Practice Address - Street 1:427 W NORTHMOOR RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-3542
Practice Address - Country:US
Practice Address - Phone:309-692-5337
Practice Address - Fax:309-693-3913
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.015153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily