Provider Demographics
NPI:1306367842
Name:MUSICK, JILLIAN MARIE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:MARIE
Last Name:MUSICK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 RIATA VALLEY RD STE B
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3678
Mailing Address - Country:US
Mailing Address - Phone:928-681-0101
Mailing Address - Fax:833-989-2165
Practice Address - Street 1:1111 RIATA VALLEY RD STE B
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3678
Practice Address - Country:US
Practice Address - Phone:286-925-5249
Practice Address - Fax:928-681-3977
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN153255363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ460555Medicaid
AZ03D2193887OtherCLIA