Provider Demographics
NPI:1942582242
Name:GOINGS, JILL (CNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:GOINGS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1414 ELBA HWY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36079-6020
Mailing Address - Country:US
Mailing Address - Phone:334-670-6726
Mailing Address - Fax:334-670-6731
Practice Address - Street 1:23 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-4444
Practice Address - Country:US
Practice Address - Phone:334-687-8051
Practice Address - Fax:334-687-8027
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.12648-NP363LF0000X
AL1-177342363LF0000X
OHAPRN.CNP.12648363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0054262Medicaid
OHH059980Medicare PIN