Provider Demographics
NPI:1366831612
Name:MEREDITH, JILL R (APRN,PNP-PC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:R
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:APRN,PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6034 W COURTYARD DR STE 110
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-5064
Mailing Address - Country:US
Mailing Address - Phone:512-328-2266
Mailing Address - Fax:
Practice Address - Street 1:345 CYPRESS CREEK RD STE 104
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4484
Practice Address - Country:US
Practice Address - Phone:512-336-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX622606363LF0000X
TXAP126871363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics