Provider Demographics
NPI:1740435353
Name:CUMMINGS, JESSICA LORRAINE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LORRAINE
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:LORRAINE
Other - Last Name:SNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:10000 N 31ST AVE STE C100-138
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-1395
Mailing Address - Country:US
Mailing Address - Phone:623-226-8455
Mailing Address - Fax:
Practice Address - Street 1:10000 N 31ST AVE STE C100-138
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-1395
Practice Address - Country:US
Practice Address - Phone:623-226-8455
Practice Address - Fax:623-401-6924
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ234488363LF0000X, 363LP0808X
IN71002838A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200926840Medicaid
IL71002838AOtherBCBS IL
IL90001076OtherBCBS IL
IN1740435353OtherANTHEM BCBS
IN71002838AOtherINDIANA LICENSE
IL90001240OtherBCBS IL
IN409950JMedicare PIN
IL90001240OtherBCBS IL