Provider Demographics
NPI:1477615060
Name:SPREITER, JILL N
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:N
Last Name:SPREITER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:N
Other - Last Name:HARDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:OK
Mailing Address - Zip Code:74016-0218
Mailing Address - Country:US
Mailing Address - Phone:918-341-8100
Mailing Address - Fax:918-341-8139
Practice Address - Street 1:206 E BLUE STARR DR
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-4223
Practice Address - Country:US
Practice Address - Phone:918-341-8100
Practice Address - Fax:918-341-8139
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS15-01453OtherKSBHA
OK1586OtherLICENSE
OK200222580AMedicaid
OK200222580AMedicaid