Provider Demographics
NPI:1912476599
Name:STOWERS, JENNA NICOLE (APRN-FPA, FNP-C)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:NICOLE
Last Name:STOWERS
Suffix:
Gender:F
Credentials:APRN-FPA, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 MAPLE CREST CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-8782
Mailing Address - Country:US
Mailing Address - Phone:217-855-8901
Mailing Address - Fax:
Practice Address - Street 1:1410 E VILLAGE PKWY STE B
Practice Address - Street 2:
Practice Address - City:MT ZION
Practice Address - State:IL
Practice Address - Zip Code:62549-1253
Practice Address - Country:US
Practice Address - Phone:217-855-7447
Practice Address - Fax:888-774-7504
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277001575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily