Provider Demographics
NPI:1497376487
Name:SPRING, JESSICA A (FNP)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:A
Last Name:SPRING
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-362-8200
Mailing Address - Fax:833-210-5713
Practice Address - Street 1:4500 MEMORIAL DR
Practice Address - Street 2:DIV SURG UROLOGY
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5360
Practice Address - Country:US
Practice Address - Phone:314-362-8200
Practice Address - Fax:833-210-5713
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420084251Medicaid