Provider Demographics
NPI:1629738018
Name:ALBERT, JESSICA K (APRN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:K
Last Name:ALBERT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 W CHRISTINE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5812
Mailing Address - Country:US
Mailing Address - Phone:309-258-2090
Mailing Address - Fax:
Practice Address - Street 1:133 SPINDER DR
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-0016
Practice Address - Country:US
Practice Address - Phone:309-308-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209024172363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily