Jessica Leigh Wagner, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209024574 Issued in IL

Practice address

3545 N Vermilion St
Danville, IL 61832-1100

Phone

(217) 442-8611

NPI assigned

Mar 10, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jessica.wagner.1@30412.direct.athenahealth.com
• Direct secure messaging: jwagnerrn288137@carlehiedirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carle Health Care Incorporated

  dba Carle Physician Group

  • Internal Medicine Physician
  • Urbana, IL
  • NPI 1154653947
  Medicare reassignment
• Champaign Integrative Clinic, PLLC

  • Primary Care Nurse Practitioner
  • Champaign, IL
  • NPI 1205777109
  NPD (past)
• Two Roads Wellness Clinic, LLC

  dba Two Roads Wellness Clinic

  • Primary Care Nurse Practitioner
  • Danville, IL
  • NPI 1417329426

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1646870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651536000000",
    "number": "1730837634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W UNIVERSITY AVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618203981",
            "telephone_number": "217-442-8611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3545 N VERMILION ST",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618321100",
            "telephone_number": "217-442-8611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JESSICA",
        "middle_name": "LEIGH",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-10",
        "last_updated": "2022-05-03",
        "certification_date": "2022-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209024574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Troy V Villaester, PT
• Vladimer Nillo Villaflor, P.T.
• Ramon Andaya Vista Jr., M.D.
• Julie Wadhams
• Jennifer Wagner, R.D.
• Michael C Wagner II, FNP
• Michelle Waites
• Andrew Nathan Wakefield, PHARMD
• Wal-Mart Stores, Inc (Vision Center 30-2491)
• Eugene Joseph Walag III, LSW

• Family Nurse Practitioner in Danville, IL
• Providers in Danville, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.