Individual
DR. JESSICA GIDDENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
600 W LINCOLN AVE, CASEYVILLE, IL 62232-1329
(618) 310-0724
Mailing address
ATTN: 614835 PO BOX 1409, 131 W HIGH ST. #1409, JEFFERSON CITY, MO 65102-1720
(314) 413-6243
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
277000634
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
277000634
STATE LICENSE IL
IL
01
—
377000614
IL PRESCRIBING LICENSE
IL
01
—
6555912834012
SURESCRIPTS
IL
Enumeration date
09/12/2013
Last updated
09/16/2024
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