Provider Demographics
NPI:1619337367
Name:ILES, JESSIE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:
Last Name:ILES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 4TH ST
Mailing Address - Street 2:# 30115
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8421
Mailing Address - Country:US
Mailing Address - Phone:318-473-4613
Mailing Address - Fax:318-445-7129
Practice Address - Street 1:501 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 250
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8124
Practice Address - Country:US
Practice Address - Phone:318-473-4613
Practice Address - Fax:318-445-7129
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily