Provider Demographics
NPI:1235687989
Name:GOSNELL, JODY (APN)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:GOSNELL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CADILLAC CT STE 6
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-1733
Mailing Address - Country:US
Mailing Address - Phone:815-494-2101
Mailing Address - Fax:
Practice Address - Street 1:205 CADILLAC CT STE 6
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-1733
Practice Address - Country:US
Practice Address - Phone:815-988-8500
Practice Address - Fax:815-977-5956
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014640363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily