Provider Demographics
NPI:1699746149
Name:POWELL, JILL L (PA)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:L
Last Name:POWELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:L
Other - Last Name:SCHEULER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2700 E 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-1242
Mailing Address - Country:US
Mailing Address - Phone:620-663-8484
Mailing Address - Fax:
Practice Address - Street 1:2700 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1242
Practice Address - Country:US
Practice Address - Phone:620-663-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500951363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200252500AMedicaid
P00262793OtherRR MEDICARE
426700Medicare ID - Type Unspecified
KS200252500AMedicaid