Provider Demographics
NPI:1336507763
Name:BESS, JILLIA (ATC)
Entity type:Individual
Prefix:MISS
First Name:JILLIA
Middle Name:
Last Name:BESS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 CLARK ST
Mailing Address - Street 2:APT B
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6535
Mailing Address - Country:US
Mailing Address - Phone:573-576-2079
Mailing Address - Fax:
Practice Address - Street 1:2401 CLARK ST
Practice Address - Street 2:APT B
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6535
Practice Address - Country:US
Practice Address - Phone:573-576-2079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-30
Last Update Date:2016-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer