Provider Demographics
NPI:1134428022
Name:MITCHELL, JILL A (FNP-BC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ANN
Other - Last Name:TIPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 632476
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2476
Mailing Address - Country:US
Mailing Address - Phone:423-794-5580
Mailing Address - Fax:423-232-8561
Practice Address - Street 1:316 MARKETPLACE BLVD STE 20
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2596
Practice Address - Country:US
Practice Address - Phone:423-794-5580
Practice Address - Fax:423-232-8561
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15708363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1526156Medicaid