Provider Demographics
NPI:1427465665
Name:MORGAN, JILLIAN DARE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:DARE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:DARE
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:82 ANTIETAM DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-9005
Mailing Address - Country:US
Mailing Address - Phone:304-290-8077
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506
Practice Address - Country:US
Practice Address - Phone:304-598-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV79015363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily