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NPI Code Detail

MEDICARE: JESSICA ANN PRINCE NP

MEDICARE: JESSICA ANN PRINCE NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner209.008990IL

General Provider Information

NPI Number : 1528349834
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA ANN PRINCE NP
Provider Business Mailing Address
First Line : PO BOX 372
Second Line :
City : MATTOON
State : IL
Zip : 61938-0372
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1201 WOODDELL WAY STE B
Second Line :
City : MATTOON
State : IL
Zip : 61938-1014
Country : US
Telephone Number : 217-238-2030
Fax Number : 217-238-3008
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2011
Last Update Date : 04/06/2026

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