Provider Demographics
NPI:1477555126
Name:KIERSCHT, JILL (NP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:KIERSCHT
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 1:100 MEDICAL PKWY
Mailing Address - Street 2:STE A
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-2614
Mailing Address - Country:US
Mailing Address - Phone:712-265-2700
Mailing Address - Fax:712-263-1777
Practice Address - Street 1:2016 1ST AVE S
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-2210
Practice Address - Country:US
Practice Address - Phone:712-263-3388
Practice Address - Fax:712-263-1777
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAJ083033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S00552Medicare UPIN
IA51660Medicare ID - Type Unspecified