Provider Demographics
NPI:1962483339
Name:MATNEY, JILL SUZANNE (C, FNP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:SUZANNE
Last Name:MATNEY
Suffix:
Gender:F
Credentials:C, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX CVPI
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-1100
Mailing Address - Country:US
Mailing Address - Phone:276-964-6771
Mailing Address - Fax:276-964-1354
Practice Address - Street 1:ONE CLINIC DR
Practice Address - Street 2:CLAYPOOL HILL
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-1100
Practice Address - Country:US
Practice Address - Phone:276-964-6771
Practice Address - Fax:276-964-1354
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010260591Medicaid
WV3810004104Medicaid
WV3810004104Medicaid