Provider Demographics
NPI:1265025910
Name:WHITWORTH, JESSICA ANN (NP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:WHITWORTH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E PRIMROSE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5154
Mailing Address - Country:US
Mailing Address - Phone:573-836-2446
Mailing Address - Fax:
Practice Address - Street 1:226 E US HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-6819
Practice Address - Country:US
Practice Address - Phone:573-873-2521
Practice Address - Fax:573-346-3307
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-13
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021005460363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty