Provider Demographics
NPI:1912104183
Name:SMOTHERS, JILL ELENE (NP)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:ELENE
Last Name:SMOTHERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2020 W COLORADO AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3882
Mailing Address - Country:US
Mailing Address - Phone:719-473-2368
Mailing Address - Fax:719-473-4581
Practice Address - Street 1:2020 W COLORADO AVE STE 303
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3882
Practice Address - Country:US
Practice Address - Phone:719-473-2368
Practice Address - Fax:719-473-4581
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704234535363L00000X
CO118390363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO40770044Medicaid
CO40770044Medicaid