Provider Demographics
NPI:1710256631
Name:MISKELL, JESSICA R (INDEPENDENT APN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:MISKELL
Suffix:
Gender:F
Credentials:INDEPENDENT APN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:R
Other - Last Name:KUYKENDALL-TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:218 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-2819
Mailing Address - Country:US
Mailing Address - Phone:815-431-1122
Mailing Address - Fax:877-503-2851
Practice Address - Street 1:218 W MADISON ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-2819
Practice Address - Country:US
Practice Address - Phone:815-431-1122
Practice Address - Fax:877-503-2851
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009286207Q00000X, 207QA0401X, 363LF0000X, 363LP2300X
IL277000895261QM1300X, 363LP2300X, 363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL277000895OtherFULL PRACTICE AUTHORITY APN
IL1710256631OtherNPI
IL2011016696OtherBOARD CERTIFIED BY ANCC
IL14D2107071OtherCLIA EXP 1/5/22
IL1750756979OtherGROUP NPI
IL041326705OtherREGISTERED NURSE