Provider Demographics
NPI:1427238823
Name:CHARRON, JESSICA L (NP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:CHARRON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 N SAINT CLAIR ST STE 19-100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5969
Mailing Address - Country:US
Mailing Address - Phone:312-664-3278
Mailing Address - Fax:312-695-5774
Practice Address - Street 1:675 N SAINT CLAIR ST STE 19-100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5969
Practice Address - Country:US
Practice Address - Phone:312-664-3278
Practice Address - Fax:312-695-5774
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006763363LA2100X, 363LA2200X, 363LA2100X
OK98623363LA2100X
MO2014042621363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00724203OtherRR MEDICARE
IL$$$$$$$$$001Medicaid
ILP00724203OtherRR MEDICARE