Provider Demographics
NPI:1528875861
Name:ELKINS, JESSICA DEANN (FNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DEANN
Last Name:ELKINS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:DEANN
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 CARTER 370
Mailing Address - Street 2:
Mailing Address - City:ELLSINORE
Mailing Address - State:MO
Mailing Address - Zip Code:63937-8191
Mailing Address - Country:US
Mailing Address - Phone:573-944-7078
Mailing Address - Fax:
Practice Address - Street 1:1906 GREENWOOD DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2433
Practice Address - Country:US
Practice Address - Phone:573-944-7078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019019286207QA0000X, 207QA0505X, 207V00000X, 208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics