Provider Demographics
NPI:1861001836
Name:FOLSOM, JILL ANITA (PMHNP-C)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:ANITA
Last Name:FOLSOM
Suffix:
Gender:F
Credentials:PMHNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SMART RD
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-7647
Mailing Address - Country:US
Mailing Address - Phone:518-569-7601
Mailing Address - Fax:
Practice Address - Street 1:8 BROAD ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-3420
Practice Address - Country:US
Practice Address - Phone:518-825-1555
Practice Address - Fax:518-825-1550
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF40308201363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health