Provider Demographics
NPI:1093290579
Name:FLOWERS, JAELA N (APRN, CNP)
Entity type:Individual
Prefix:
First Name:JAELA
Middle Name:N
Last Name:FLOWERS
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:JAELA
Other - Middle Name:N
Other - Last Name:NEWBOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-5115
Mailing Address - Country:US
Mailing Address - Phone:217-788-3792
Mailing Address - Fax:217-788-5562
Practice Address - Street 1:501 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5115
Practice Address - Country:US
Practice Address - Phone:217-788-3792
Practice Address - Fax:217-788-5562
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041368256OtherRN LICENSE