Provider Demographics
NPI:1790228575
Name:FOLEY, JILLIAN R (PA-C)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:R
Last Name:FOLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:R
Other - Last Name:RANKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:531 SASANQUA LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-9803
Mailing Address - Country:US
Mailing Address - Phone:724-244-5896
Mailing Address - Fax:
Practice Address - Street 1:701 LADY ST STE B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3077
Practice Address - Country:US
Practice Address - Phone:803-708-0178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058775363A00000X
SC4734363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant