Healthcare Provider Details

I. General information

NPI: 1174912364
Provider Name (Legal Business Name): JESSICA LYNNE HEIL MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N 1ST ST
SPRINGFIELD IL
62781-0001
US

IV. Provider business mailing address

2516 DENLO CT
FENTON MO
63026-2277
US

V. Phone/Fax

Practice location:
  • Phone: 217-788-3891
  • Fax:
Mailing address:
  • Phone: 217-825-8083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.426499
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.012368
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: