Healthcare Provider Details

I. General information

NPI: 1164336061
Provider Name (Legal Business Name): JACKELYN M JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 WILLIAM LATHAM DR STE 301
BOURBONNAIS IL
60914-2450
US

IV. Provider business mailing address

5000 S 5TH AVE
HINES IL
60141-3030
US

V. Phone/Fax

Practice location:
  • Phone: 815-932-3823
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041505612
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: