Provider Demographics
NPI:1700800372
Name:HUPFER, JILL S (PA-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:S
Last Name:HUPFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:S
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2211 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-4220
Mailing Address - Country:US
Mailing Address - Phone:765-640-2100
Mailing Address - Fax:765-640-2105
Practice Address - Street 1:2211 BROWN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4220
Practice Address - Country:US
Practice Address - Phone:765-640-2100
Practice Address - Fax:765-640-2105
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000667A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INQ18608Medicare UPIN
IN313400HMedicare ID - Type Unspecified