Provider Demographics
NPI:1801840269
Name:CLEMMENT, JILL D (CRNA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:D
Last Name:CLEMMENT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:SHETLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:864-797-6198
Practice Address - Street 1:7 INDEPENDENCE PT STE 3002ND
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4566
Practice Address - Country:US
Practice Address - Phone:864-522-3700
Practice Address - Fax:864-522-3705
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN857367500000X
SC857367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20031911OtherSELECT HEALTH GROUP
SCAN0605Medicaid
SC20033826OtherSELECT HEALTH IND ID
SCQ31022Medicare ID - Type UnspecifiedMEDICARE ID