Individual
JENNIFER DERRICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
2512 HURST DR, MATTOON, IL 61938-9200
(217) 258-5900
Mailing address
611 W PARK ST, FAPC, URBANA, IL 61801
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209028677
IL
Other
Enumeration date
02/05/2024
Last updated
10/20/2025
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