Individual
JESSICA N BAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
404 S LEWIS LN, CARBONDALE, IL 62901
(618) 519-9200
(618) 549-1288
Mailing address
PO BOX 577, 109 CALIFORNIA ST, CARTERVILLE, IL 62918-0577
(618) 519-9200
(618) 985-4635
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041441276
IL
363LF0000X
Family Nurse Practitioner
Primary
029.019857
IL
Other
Enumeration date
08/08/2019
Last updated
02/09/2023
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