Provider Demographics
NPI:1710071329
Name:CELESTSKYE, JILL D (FNPC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:D
Last Name:CELESTSKYE
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 CHEVY WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4127
Mailing Address - Country:US
Mailing Address - Phone:541-690-3555
Mailing Address - Fax:
Practice Address - Street 1:1955 SCENIC AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-1652
Practice Address - Country:US
Practice Address - Phone:541-494-6417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR087000069N1 FNP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORS45238OtherCOMMERICAL
OR000147Medicaid
ORS45238OtherCOMMERICAL
OR132292Medicare PIN
ORH2549-06OtherPACIFIC SOURCE
OR132292Medicare PIN
ORS45328Medicare UPIN