MRS. JESSICA-LYNN MARIE FULTON (NPI# 1114279841) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114279841 |
| Entity Type | Individual |
| Full Name | MRS. JESSICA-LYNN MARIE FULTON |
| Credential | APN |
| Practice Address |
530 Ne Glen Oak Ave Peoria IL 61637-0001 |
| Mailing Address |
115 Cotton Ln East Peoria IL 61611-4011 |
| Practice Telephone | 3096240631 |
| Mailing Telephone | 3092357004 |
| Enumeration Date | 2012-10-04 |
| Last Update Date | 2017-03-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LN0000X |
Nurse Practitioner Specialization: Neonatal |
209009870 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LN0005X |
Nurse Practitioner Specialization: Neonatal, Critical Care |
K146206 | IA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
530 NE GLEN OAK AVE |
| City | PEORIA |
| State | IL |
| Zip Code | 61637-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346235777 | Jack Michael Gibson | Obstetrics & Gynecology | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2005-09-12 |
| 1053912188 | Janie Clary | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-11-04 |
| 1265030548 | Christina David | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-10-09 |
| 1033726831 | Corry Lynn Rediger | Occupational Therapist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-09-25 |
| 1720694094 | Katelynn M Madden | Clinical Nurse Specialist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-09-21 |
| 1568074474 | Amanda Diane Beoletto | Pharmacist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-08-21 |
| 1881212892 | Mohammad Mousbah Al-tabbaa | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-07-07 |
| 1750909693 | Mohammad Gareeb | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-07-07 |
| 1376160846 | Bassel Elia Abouzeid | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave, Peoria, IL 61637 | 2020-07-01 |
| 1700403516 | Christina Marie Spurgeon | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-06-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780200865 | Kuang Chuen Liu | Pediatrics | 530 Ne Glen Oak Ave, Peoria, Peoria, IL 61637 | 2020-06-24 |
| 1174184527 | Manisha Tharoor | Student in an Organized Health Care Education/Training Program | 530 N.e Glen Oak Ave, Peoria, IL 61637 | 2019-06-26 |
| 1609436724 | Sriviji Senthil Kumaran | Student in an Organized Health Care Education/Training Program | 530. N.e Glen Oak Ave., Peoria, IL 61637 | 2019-06-20 |
| 1780240929 | Abuzar Ali Asif | Student in an Organized Health Care Education/Training Program | 530 N. E. Glen Oak Ave., Peoria, IL 61637 | 2019-05-14 |
| 1518328665 | Jenna Bishop | Dietitian, Registered | 600 Ne Water Street, Peoria, IL 61637 | 2016-03-17 |
| 1194133850 | Ashish Kumar Roy | Internal Medicine | 530 N.e. Glen Oak Ave, Peoria, IL 61637 | 2014-07-25 |
| 1265720510 | Reuben Antony | Pediatrics | 530 Ne Glen Oak Ave., C/o Ms Suzy Lewellen, Peoria, IL 61637 | 2011-07-20 |
| 1366673436 | Joseph William Hauter | Emergency Medicine | 830 Ne Glen Oak Ave, Peoria, IL 61637 | 2009-08-06 |
| 1437380748 | Jeremy R Monroe | Emergency Medicine | 530 Glen Oak, Osf St Francis Medical Center, Peoria, IL 61637 | 2009-08-04 |
| 1326244682 | Maria S. Parr | Psychiatry & Neurology | Osf Saint Francis Medical Center, 530 N.e.glen Oak Ave., Peoria, FL 61637 | 2007-06-25 |
| Find all providers in zip 61637 | ||||
| Taxonomy Code | 363LN0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Neonatal |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316299456 | Jesse Lee Henneberg | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2012-10-14 |
| 1891018891 | Janessa Michele Jenkins | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2010-03-04 |
| 1225351323 | Sharon Kay Leonard | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2010-03-04 |
| 1568791234 | Kelli Dohman | Nurse Practitioner | 530 Ne Glenoak Ave, Peoria, IL 61603-3117 | 2009-12-09 |
| 1497911713 | Jeanne M Perino | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2008-08-06 |
| 1013173335 | Suzanne D Tietjen | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2008-08-06 |
| 1710143037 | Sharon A Klein | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2008-08-06 |
| 1417113739 | Julie Marie Strandberg | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2008-08-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699381707 | Jamie Kaye Summers | Nurse Practitioner | 522 Clover Ct, Gibson City, IL 60936-1901 | 2020-09-23 |
| 1447697032 | Jessica Sue Krause | Nurse Practitioner | 1750 W Harrison St Fl 6, Chicago, IL 60612-3825 | 2013-05-23 |
| 1164798641 | Kate M Reed | Nurse Practitioner | 25 Thorndale Ct, South Elgin, IL 60177-3202 | 2012-03-28 |
| 1982975694 | Tiffany Amber Deriggi | Nurse Practitioner | 3831 N Sacramento Ave, Apt 1, Chicago, IL 60618-3530 | 2012-01-26 |
| 1154590214 | Patricia Mary Lumb | Nurse Practitioner | 2600 Children's Plaza, Chicago, IL 60614 | 2008-02-22 |
| 1841468139 | Mimi Noelle Hussussian | Nurse Practitioner | Children's Memorial Hospital, 2300children's Plaza, Box #253, Chicago, IL 60614 | 2008-02-20 |
| 1366610107 | Patricia Freeman Stevens | Nurse Practitioner | 316 N Park Rd, La Grange Park, IL 60526-1801 | 2008-02-14 |
| 1225250723 | Carolyn Patricia Seng | Nurse Practitioner | 5721 S. Maryland Ave, Chicago, IL 60637 | 2007-05-03 |
| 1487767117 | Robert Anthony Wisdom | Nurse Practitioner | 4444 S Prairie Ave, Chicago, IL 60653-3208 | 2006-08-16 |
| 1538771340 | Jennifer Aileen Burkett | Nurse Practitioner | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2020-08-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.