Provider Demographics
NPI:1891562203
Name:DICKEY, JILL M (AGACNP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:DICKEY
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:M
Other - Last Name:KITCHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:350 GARNER DR
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-1555
Mailing Address - Country:US
Mailing Address - Phone:330-571-3609
Mailing Address - Fax:
Practice Address - Street 1:350 GARNER DRIVE
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-4426
Practice Address - Country:US
Practice Address - Phone:330-571-3609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0035501363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology