Healthcare Provider Details

I. General information

NPI: 1639304967
Provider Name (Legal Business Name): JYLL TERESE HOPKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JYLL TERESE NICHOLSON

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S LANDMARK AVE
BLOOMINGTON IN
47403-3239
US

IV. Provider business mailing address

642 S WALKER ST
BLOOMINGTON IN
47403-2158
US

V. Phone/Fax

Practice location:
  • Phone: 812-331-9160
  • Fax: 812-336-0277
Mailing address:
  • Phone: 812-331-9160
  • Fax: 812-336-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71002996A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: