Healthcare Provider Details

I. General information

NPI: 1578337747
Provider Name (Legal Business Name): LINDA JENNINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 12/07/2025
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 OLD WAGON RD
KNOXVILLE IL
61448-9577
US

IV. Provider business mailing address

1337 OLD WAGON RD
KNOXVILLE IL
61448-9577
US

V. Phone/Fax

Practice location:
  • Phone: 309-368-2599
  • Fax:
Mailing address:
  • Phone: 309-368-2599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: