Provider Demographics
NPI:1417681321
Name:HATFIELD, JILLIAN
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:
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 72
Mailing Address - Street 2:
Mailing Address - City:BUD
Mailing Address - State:WV
Mailing Address - Zip Code:24716-0072
Mailing Address - Country:US
Mailing Address - Phone:304-309-6185
Mailing Address - Fax:
Practice Address - Street 1:446 ALPOCA RD
Practice Address - Street 2:
Practice Address - City:BUD
Practice Address - State:WV
Practice Address - Zip Code:24716
Practice Address - Country:US
Practice Address - Phone:304-309-6185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant