Provider Demographics
NPI:1639304967
Name:HOPKINS, JYLL TERESE
Entity Type:Individual
Prefix:
First Name:JYLL
Middle Name:TERESE
Last Name:HOPKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JYLL
Other - Middle Name:TERESE
Other - Last Name:NICHOLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:642 S WALKER ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2158
Mailing Address - Country:US
Mailing Address - Phone:812-331-9160
Mailing Address - Fax:812-336-0277
Practice Address - Street 1:550 S LANDMARK AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-3239
Practice Address - Country:US
Practice Address - Phone:812-331-9160
Practice Address - Fax:812-336-0277
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002996A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health