Provider Demographics
NPI:1063421048
Name:FEURT, JILL LYNN (CNM FNP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:LYNN
Last Name:FEURT
Suffix:
Gender:F
Credentials:CNM FNP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:FEURT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM FNP
Mailing Address - Street 1:1615 HAZEL AVE
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-3020
Mailing Address - Country:US
Mailing Address - Phone:417-358-0188
Mailing Address - Fax:417-358-4162
Practice Address - Street 1:1515 HAZEL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-2850
Practice Address - Country:US
Practice Address - Phone:417-358-0188
Practice Address - Fax:417-358-4162
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO138781363LF0000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200264510AMedicaid
MO1063421048Medicaid