Provider Demographics
NPI:1841975869
Name:SMITH, JILL RAYE
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:RAYE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
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 87
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:OH
Mailing Address - Zip Code:43931-0087
Mailing Address - Country:US
Mailing Address - Phone:304-435-9855
Mailing Address - Fax:
Practice Address - Street 1:411 N STATE ROUTE 2
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-2711
Practice Address - Country:US
Practice Address - Phone:304-455-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV29499164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse