Healthcare Provider Details

I. General information

NPI: 1306218565
Provider Name (Legal Business Name): JESSICA DEVAULT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA D. ROGERS ARNP

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 E CROSS ST
CENTERVILLE IA
52544-3501
US

IV. Provider business mailing address

1208 E CROSS ST
CENTERVILLE IA
52544-3501
US

V. Phone/Fax

Practice location:
  • Phone: 515-293-4068
  • Fax: 914-259-5306
Mailing address:
  • Phone: 515-293-4068
  • Fax: 914-259-5306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA115887
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA115887
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: