Provider Demographics
NPI:1609354315
Name:TAYLOR, JESSICA LORRAINE (APRN ,DNP, CNM)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LORRAINE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:APRN ,DNP, CNM
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Mailing Address - Street 1:544 W PERSHING RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-3226
Mailing Address - Country:US
Mailing Address - Phone:217-872-2400
Mailing Address - Fax:217-875-4680
Practice Address - Street 1:520 N 4TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5238
Practice Address - Country:US
Practice Address - Phone:217-545-8000
Practice Address - Fax:217-757-8161
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN9492930367A00000X
IL209024795367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100819800Medicaid