Provider Demographics
NPI:1619074945
Name:MACFARLANE, JILL KAY (RD)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:KAY
Last Name:MACFARLANE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 N CENTRAL AVENUE, STE 400
Mailing Address - Street 2:AKDHC, LLC
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15255 NORTH 40TH STREET
Practice Address - Street 2:BLDG 5 STE 135
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-0000
Practice Address - Country:US
Practice Address - Phone:602-943-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ209946Medicaid
AZ209946Medicaid