Provider Demographics
NPI:1851317051
Name:BENNETT, JILL A (APRN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:BENNETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ANNETTE
Other - Last Name:SMOTHERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:641 RB WILSON DR
Practice Address - Street 2:SUITE G
Practice Address - City:HUNTINGDON
Practice Address - State:TN
Practice Address - Zip Code:38344
Practice Address - Country:US
Practice Address - Phone:731-986-7400
Practice Address - Fax:731-986-7402
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8197363LF0000X, 363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1522156Medicaid
TN4101858OtherBLUE CROSS
AR214610758Medicaid
TN4101858OtherBLUE CROSS
P71983Medicare UPIN
TN1522156Medicaid
TN1522156Medicaid
TNP71983Medicare UPIN