Provider Demographics
NPI:1437345899
Name:SYPOLT, JILL ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ELIZABETH
Last Name:SYPOLT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 WASHINGTON ST W
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-2036
Mailing Address - Country:US
Mailing Address - Phone:304-344-9841
Mailing Address - Fax:304-344-1756
Practice Address - Street 1:510 WASHINGTON ST W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2036
Practice Address - Country:US
Practice Address - Phone:304-344-9841
Practice Address - Fax:304-344-1756
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV47643364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0006834000Medicaid
WV237186OtherUPIN