Jessica L Carlson

Primary specialty

Military Health Care ProviderTaxonomy code 171000000X

Practice address

112 W 9TH St
Coal Valley, IL 61240-9120

Phone

(309) 644-2870

NPI assigned

Dec 15, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jessica McCarty Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607990400000",
    "number": "1205422011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 W 9TH ST",
            "city": "COAL VALLEY",
            "state": "IL",
            "postal_code": "612409120",
            "telephone_number": "309-644-2870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 W 9TH ST",
            "city": "COAL VALLEY",
            "state": "IL",
            "postal_code": "612409120",
            "telephone_number": "309-644-2870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "JESSICA",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-15",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "IA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "MCCARTY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nathan C Ackert
• Daisy Anderson
• Arrowhead Ranch
• Arrowhead Ranch Inc.
• Coal Valley Chiropractic Clinic, Inc.
• Coal Valley Fire Protection District
• Katrina Corgan, PTA
• Des Moines Mental Health Center, PLLC
• Karen Ann Dhanens, OTR L

• Military Health Care Provider in Coal Valley, IL
• Providers in Coal Valley, IL by specialty
• Military Health Care Provider in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.