Provider Demographics
NPI:1962960393
Name:SCHUPP, JESSICA L (APRN, CNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:SCHUPP
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:MCALLISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2265 W ALTORFER DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1807
Mailing Address - Country:US
Mailing Address - Phone:309-683-7700
Mailing Address - Fax:309-683-7752
Practice Address - Street 1:2265 W ALTORFER DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1807
Practice Address - Country:US
Practice Address - Phone:309-683-7700
Practice Address - Fax:309-683-7752
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018917363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily