Individual
JACKLYN M FITZPATRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
907 N COURT ST, MARION, IL 62959-1631
(618) 218-1200
Mailing address
1144 W WEBSTER ST, BENTON, IL 62812-1548
(618) 218-1200
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
209.012480
IL
363LG0600X
Gerontology Nurse Practitioner
Primary
209012480
IL
363LP2300X
Primary Care Nurse Practitioner
209.012480
IL
363LP2300X
Primary Care Nurse Practitioner
Primary
277.005066
IL
Other
Enumeration date
03/31/2015
Last updated
05/05/2026
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