Healthcare Provider Details

I. General information

NPI: 1942047618
Provider Name (Legal Business Name): JESSICA SCHILKE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PERKINS FARM DR STE 301
MYSTIC CT
06355-4041
US

IV. Provider business mailing address

100 PERKINS FARM DR STE 301
MYSTIC CT
06355-4041
US

V. Phone/Fax

Practice location:
  • Phone: 860-572-5400
  • Fax: 860-245-0001
Mailing address:
  • Phone: 860-572-5400
  • Fax: 860-245-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number12.013468
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number13468
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN04189
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: