Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Nicole M. Jack, PA-C

Individual provider Physician Assistant · NPI 1083104137

Nicole M. Jack, PA-C is a Physician Assistant in Pontiac, Illinois. Qualified in 2017, 9 years ago. Practices with Memorial Physician Services, a 158-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Illinois.

Years since qualifying
9
Licensed in
IL
In the registry since
2018
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Practice location Address checks out

2500 W Reynolds St
Pontiac, IL 61764
Phone: (815) 844-5343
Fax: (815) 844-5715
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 085006579 (IL)

Record details

NPI number1083104137
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMay 15, 2018
Last updated in NPPESJune 18, 2018

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Memorial Physician Services — 158 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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