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JENNA DIVELY FNP-C
NPI 1508747387
Nurse Practitioner - Family in Canton, IL

Active since September 09, 2025
210 W WALNUT ST, CANTON, IL 61520(309) 647-0201 Get Directions Write a Review

NPPES record last updated: September 9, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Jenna Dively Fnp-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JENNA DIVELY FNP-C (NPI 1508747387) is an individual family provider in Canton, Illinois, licensed in Illinois (209.033183) and active in the NPI registry since September 2025. She is a graduate of Other (2025).

NPPES Registry Identity

NPI1508747387
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameJENNA DIVELYCredential: FNP-C
Location Address210 W WALNUT STCanton, IL 61520-2497
Mailing Address1133 Woodland TrlMacomb, IL 61455-3522
Phone(309) 647-0201
Sole ProprietorNo
Medical School CMSOtherGraduated 2025
Enumeration DateSeptember 9, 2025
NPPES CertifiedSeptember 9, 2025
✔ NPI 1508747387 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in IL · 209.033183
210 W WALNUT ST, Canton, IL 61520
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jenna Dively Fnp-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1759860661
PECOS Enrollment IDI20260211000840

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DELLA EETEN CRNA
Nurse Anesthetist, Certified Registered
210 W WALNUT ST
CANTON, IL 61520
Fulton County (309) 647-5240
GERRI DELOST CRNA
Nurse Anesthetist, Certified Registered
210 W WALNUT ST
CANTON, IL 61520
Fulton County (309) 647-5240
TRACY ANN IVERSEN PMHNP
Nurse Practitioner (Psychiatric/Mental Health)
210 W WALNUT ST
CANTON, IL 61520
Fulton County (309) 647-0201
RYAN DEUSHANE CRNA
Nurse Anesthetist, Certified Registered
210 W WALNUT ST
CANTON, IL 61520
Fulton County (309) 339-8414
GRAHAM HOSPITAL ASSOCIATION
Skilled Nursing Facility
210 W WALNUT ST
CANTON, IL 61520
Fulton County (309) 647-5240
GRAHAM HOSPITAL ASSOCIATION
General Acute Care Hospital (Critical Access)
210 W WALNUT ST
CANTON, IL 61520
Fulton County (309) 647-5240
LORNA EATON
Physical Therapy Assistant
210 W WALNUT ST
CANTON, IL 61520
Fulton County (309) 647-5240
CHRISTINA WILLEY OT
Occupational Therapist
210 W WALNUT ST
CANTON, IL 61520
Fulton County (309) 647-5240

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jenna Dively's NPI number?

The NPI number for Jenna Dively is 1508747387. It was assigned to this individual provider in the NPPES registry on September 9, 2025.

Where is Jenna Dively located?

Jenna Dively practices at 210 W Walnut St, Canton, IL 61520. The listed phone number is (309) 647-0201.

What is Jenna Dively's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Jenna Dively enrolled in Medicare?

Yes. Jenna Dively is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jenna Dively was last updated on September 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.