Provider Demographics
NPI:1124682315
Name:SHIRLEY, JILL BELL
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:BELL
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5617A HIGHWAY 185
Mailing Address - Street 2:
Mailing Address - City:HODGES
Mailing Address - State:SC
Mailing Address - Zip Code:29653-9508
Mailing Address - Country:US
Mailing Address - Phone:864-941-0757
Mailing Address - Fax:
Practice Address - Street 1:105 VINECREST CT STE 1000
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-8031
Practice Address - Country:US
Practice Address - Phone:864-725-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22809363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily