Provider Demographics
NPI:1104529601
Name:BARRY, JILLIAN ROSE (CNP)
Entity type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:ROSE
Last Name:BARRY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MRS
Other - First Name:JILLIAN
Other - Middle Name:ROSE
Other - Last Name:METZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:191 CLYDE ST
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2903
Mailing Address - Country:US
Mailing Address - Phone:508-742-7181
Mailing Address - Fax:
Practice Address - Street 1:291 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3628
Practice Address - Country:US
Practice Address - Phone:617-541-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2308907207R00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine