Provider Demographics
NPI:1629608187
Name:MCCARTER, JILLIAN R
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:R
Last Name:MCCARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 CLINTON HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1319
Mailing Address - Country:US
Mailing Address - Phone:614-738-4431
Mailing Address - Fax:
Practice Address - Street 1:610 CLINTON HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-1319
Practice Address - Country:US
Practice Address - Phone:614-738-4431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker