Healthcare Provider Details

I. General information

NPI: 1184548299
Provider Name (Legal Business Name): ELEVATE SI HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 BROWN SECTION RD
COBDEN IL
62920-3308
US

IV. Provider business mailing address

920 BROWN SECTION RD
COBDEN IL
62920-3308
US

V. Phone/Fax

Practice location:
  • Phone: 618-697-0268
  • Fax:
Mailing address:
  • Phone: 618-697-0268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA ELIZABETH WILLS
Title or Position: NURSE PRACTITIONER
Credential: APRN-FPA, FNP-BC
Phone: 618-697-0268