Provider Demographics
NPI:1114118510
Name:LANKFORD, JILLIAN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:ANN
Last Name:LANKFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 WASHINGTON AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-7144
Mailing Address - Country:US
Mailing Address - Phone:616-355-3926
Mailing Address - Fax:
Practice Address - Street 1:854 WASHINGTON AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7144
Practice Address - Country:US
Practice Address - Phone:616-355-3926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090068482084N0400X
MI43010994082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology