Healthcare Provider Details

I. General information

NPI: 1073326625
Provider Name (Legal Business Name): JESSICA LYNN PORTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LYNN DEAL

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 E HOME RD
SPRINGFIELD OH
45503-2725
US

IV. Provider business mailing address

PO BOX 734439
CHICAGO IL
60673-4439
US

V. Phone/Fax

Practice location:
  • Phone: 937-342-1619
  • Fax:
Mailing address:
  • Phone: 614-383-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0037225
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: