Provider Demographics
NPI:1215988134
Name:MYERS, JILL A (NP)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:A
Last Name:MYERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4857 STATE ROUTE 5
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:13476-3530
Mailing Address - Country:US
Mailing Address - Phone:315-363-9995
Mailing Address - Fax:315-363-9686
Practice Address - Street 1:4857 STATE ROUTE 5
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:NY
Practice Address - Zip Code:13476-3530
Practice Address - Country:US
Practice Address - Phone:315-363-9995
Practice Address - Fax:315-363-9686
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331588363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF331588OtherLICENSE