Healthcare Provider Details

I. General information

NPI: 1750096392
Provider Name (Legal Business Name): JILLIAN JEMISON DNP, WHNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5104 ROTARY RD
CHERRY VALLEY IL
61016-9602
US

IV. Provider business mailing address

PO BOX 1241
LAND O LAKES FL
34639-1241
US

V. Phone/Fax

Practice location:
  • Phone: 727-967-1062
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209.035659
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number11024000
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11024000
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.035659
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: