Provider Demographics
NPI:1033544747
Name:GIDDENS, JESSICA (PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:GIDDENS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:WHELAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:ATTN: 614835 PO BOX 1409
Mailing Address - Street 2:131 W HIGH ST. #1409
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65102-1720
Mailing Address - Country:US
Mailing Address - Phone:314-413-6243
Mailing Address - Fax:
Practice Address - Street 1:600 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CASEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62232-1329
Practice Address - Country:US
Practice Address - Phone:618-310-0724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000634363LP0808X, 163WA0400X, 163WC1600X, 163WG0000X, 163WN0800X, 1744R1102X, 2084P0301X, 364SC2300X, 364SH1100X, 364SP0810X, 364SP0811X, 364SP0812X, 364SP0813X, 363LP0808X
MO2013029034363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience
No1744R1102XOther Service ProvidersSpecialistResearch Study
No2084P0301XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBrain Injury Medicine
No364SC2300XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistChronic Care
No364SH1100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHolistic
No364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family
No364SP0811XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Chronically Ill
No364SP0812XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Community
No364SP0813XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Geropsychiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6555912834012OtherSURESCRIPTS
IL377000614OtherIL PRESCRIBING LICENSE
IL277000634OtherSTATE LICENSE IL