Healthcare Provider Details

I. General information

NPI: 1912476599
Provider Name (Legal Business Name): JENNA NICOLE STOWERS APRN-FPA, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LEWIS PARK DR
MT ZION IL
62549-1202
US

IV. Provider business mailing address

6330 MAPLE CREST CT
DECATUR IL
62521-8782
US

V. Phone/Fax

Practice location:
  • Phone: 217-855-7447
  • Fax: 888-774-7504
Mailing address:
  • Phone: 217-855-8901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277001575
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: