Provider Demographics
NPI:1750533717
Name:JARVIS, JILL C (PA)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:C
Last Name:JARVIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:C
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:200 E CHESTNUT ST STE 303
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1831
Practice Address - Country:US
Practice Address - Phone:502-629-5552
Practice Address - Fax:502-629-3132
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA864363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000601231OtherANTHEM- NORTON INPATIENT SPECIALISTS
KY000023036KOtherHUMANA- NORTON INPATIENT SPECIALISTS
KY50023389OtherPASSPORT- NORTON INPATIENT SPECIALISTS
KY7100089510Medicaid
KY00533095OtherMEDICARE- NORTON INPATIENT SPECIALISTS
KY3706976000OtherPASSPORT ADVANTAGE- NORTON INPATIENT SPECIALISTS
KY7100089510Medicaid