Provider Demographics
NPI:1548399751
Name:AUGUSTINE, JILL A (ARNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:A
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:
Practice Address - Street 1:3311 E. MURDOCK
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208
Practice Address - Country:US
Practice Address - Phone:316-689-9370
Practice Address - Fax:316-689-9363
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS46012363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
003719456OtherMEDICARE
KS161970Medicare PIN