Healthcare Provider Details

I. General information

NPI: 1942807516
Provider Name (Legal Business Name): JESSICA A. ALFORD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E US HIGHWAY 36
TUSCOLA IL
61953-8020
US

IV. Provider business mailing address

1250 E US HIGHWAY 36
TUSCOLA IL
61953-8020
US

V. Phone/Fax

Practice location:
  • Phone: 217-253-4137
  • Fax: 217-253-3421
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209.021614
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: