Provider Demographics
NPI:1699381707
Name:SUMMERS, JAMIE KAYE (DNP, NNP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:KAYE
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:DNP, NNP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:KAYE
Other - Last Name:BOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1304 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-3558
Mailing Address - Country:US
Mailing Address - Phone:309-268-8413
Mailing Address - Fax:309-268-2820
Practice Address - Street 1:1304 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3558
Practice Address - Country:US
Practice Address - Phone:309-268-8413
Practice Address - Fax:309-268-2820
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.021162363LN0000X
IL209021162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209.021162OtherLICENSE