Healthcare Provider Details

I. General information

NPI: 1376980599
Provider Name (Legal Business Name): JESSICA LYNN SKINNER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA BURNIGHT

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W BLACKHAWK DR
BYRON IL
61010-8988
US

IV. Provider business mailing address

PO BOX 78866
MILWAUKEE WI
53278-8866
US

V. Phone/Fax

Practice location:
  • Phone: 779-696-1300
  • Fax: 815-234-2314
Mailing address:
  • Phone: 779-696-7150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209010347
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: