Provider Demographics
NPI:1073561676
Name:LILLEY, JANE JONES (FNP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:JONES
Last Name:LILLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23974-0070
Mailing Address - Country:US
Mailing Address - Phone:434-696-2165
Mailing Address - Fax:434-696-1557
Practice Address - Street 1:702 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1242
Practice Address - Country:US
Practice Address - Phone:434-634-7723
Practice Address - Fax:434-634-7725
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004287363LF0000X
VA0024166268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1073561676Medicaid
VA010106940Medicaid
VA8K6726Medicare PIN
VA010106940Medicaid
VA1073561676Medicaid