Healthcare Provider Details

I. General information

NPI: 1174739205
Provider Name (Legal Business Name): JESSICA M MITCHELL APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA RAMSEY

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NE GLEN OAK AVE
PEORIA IL
61637-0001
US

IV. Provider business mailing address

111 OAKWOOD RD
EAST PEORIA IL
61611-1853
US

V. Phone/Fax

Practice location:
  • Phone: 309-624-8818
  • Fax: 309-624-8820
Mailing address:
  • Phone: 309-740-4272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number041325897
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209-006817
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209006817
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: