Individual
ABBY MARIE MEDFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
390 MAPLE SUMMIT RD, JERSEYVILLE, IL 62052-2000
(618) 498-2101
(618) 498-8153
Mailing address
390 MAPLE SUMMIT RD, JERSEYVILLE, IL 62052-2000
(618) 498-7518
(618) 498-3052
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085010750
IL
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085010750
IL STATE LICENSE - PA
IL
01
—
1134163827
GROUP NPI - JCH MEDICAL GROUP
IL
01
—
1219129
NCCPA ID
IL
01
—
16340134
CAQH ID
IL
01
—
1811392970
RURAL HEALTH CLINIC NPI
IL
Enumeration date
08/16/2024
Last updated
03/10/2026
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