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
State | License ID | Taxonomies |
---|---|---|
OR | 087000069N1 FNP | 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OR | S45238 | Other | COMMERICAL |
OR | 000147 | Medicaid | |
OR | S45238 | Other | COMMERICAL |
OR | 132292 | Medicare PIN | |
OR | H2549-06 | Other | PACIFIC SOURCE |
OR | 132292 | Medicare PIN | |
OR | S45328 | Medicare UPIN |