Provider Demographics
NPI:1750715827
Name:NESBITT, JILL SUZANNE (LP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:SUZANNE
Last Name:NESBITT
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 W 6TH ST B 199
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66045-7559
Mailing Address - Country:US
Mailing Address - Phone:778-874-3964
Mailing Address - Fax:
Practice Address - Street 1:4000 W 6TH ST B 199
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66045-7559
Practice Address - Country:US
Practice Address - Phone:778-874-3964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2023-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2487103TC0700X
KS2535103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical