Healthcare Provider Details

I. General information

NPI: 1922458405
Provider Name (Legal Business Name): JESSICA LYNN ALSTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 WEST AVE STE 223
ORLAND PARK IL
60462-4509
US

IV. Provider business mailing address

15300 WEST AVE STE 223
ORLAND PARK IL
60462-4509
US

V. Phone/Fax

Practice location:
  • Phone: 708-226-2440
  • Fax: 708-923-8596
Mailing address:
  • Phone: 708-226-2440
  • Fax: 708-923-8596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036161916
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: