Healthcare Provider Details

I. General information

NPI: 1629738018
Provider Name (Legal Business Name): JESSICA K ALBERT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 12/27/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 SPINDER DR
EAST PEORIA IL
61611-0016
US

IV. Provider business mailing address

1412 W CHRISTINE AVE
PEORIA IL
61614-5812
US

V. Phone/Fax

Practice location:
  • Phone: 309-308-5100
  • Fax:
Mailing address:
  • Phone: 309-258-2090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209024172
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: