Provider Demographics
NPI:1104100825
Name:HARPER, JILL ADAIR (CRNA)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ADAIR
Last Name:HARPER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ADAIR
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4504 STARKEY RD
Mailing Address - Street 2:STE 200
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-8535
Mailing Address - Country:US
Mailing Address - Phone:336-718-5389
Mailing Address - Fax:336-718-9271
Practice Address - Street 1:76 PEACHTREE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3395
Practice Address - Country:US
Practice Address - Phone:336-718-5389
Practice Address - Fax:336-718-9271
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173472367500000X
NC172156367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered