Provider Demographics
NPI:1578825006
Name:FRAZELL, JILLINA L (APRN)
Entity Type:Individual
Prefix:
First Name:JILLINA
Middle Name:L
Last Name:FRAZELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JILLINA
Other - Middle Name:L
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 736
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-0736
Mailing Address - Country:US
Mailing Address - Phone:620-820-5800
Mailing Address - Fax:620-820-5821
Practice Address - Street 1:2613 SOUTH SANTA FE
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720
Practice Address - Country:US
Practice Address - Phone:620-820-5800
Practice Address - Fax:620-820-5821
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-101821-112163W00000X
KSTMP 145378363L00000X
KS53-75722-112363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse