Provider Demographics
NPI:1437348208
Name:FREEMYER, JILL M (CNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:FREEMYER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:M
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:3005 HILLRISE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4703
Mailing Address - Country:US
Mailing Address - Phone:575-525-3980
Mailing Address - Fax:575-523-8660
Practice Address - Street 1:3005 HILLRISE DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4703
Practice Address - Country:US
Practice Address - Phone:575-525-3980
Practice Address - Fax:575-523-8660
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR62168363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM006J93OtherBCBS OF NM
NMNM006J93OtherBCBS OF NM