Provider Demographics
NPI:1487355368
Name:KEARNS, JENNIFER CHRISTINE (ARNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHRISTINE
Last Name:KEARNS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:61257-9658
Mailing Address - Country:US
Mailing Address - Phone:517-526-0421
Mailing Address - Fax:
Practice Address - Street 1:ONE RIVER PLACE
Practice Address - Street 2:1225 E RIVER DR STE 234
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803
Practice Address - Country:US
Practice Address - Phone:563-232-9483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG173264363LP0808X
IL209.028823363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health