Provider Demographics
NPI:1396294336
Name:MCGEE, JESSICA (FNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MCGEE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15238 N 1090 EAST RD
Mailing Address - Street 2:
Mailing Address - City:CATLIN
Mailing Address - State:IL
Mailing Address - Zip Code:61817-9263
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15238 N 1090 EAST RD
Practice Address - Street 2:
Practice Address - City:CATLIN
Practice Address - State:IL
Practice Address - Zip Code:61817-9263
Practice Address - Country:US
Practice Address - Phone:217-260-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.368487163WN0002X
IL209014853363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily