Healthcare Provider Details

I. General information

NPI: 1205271756
Provider Name (Legal Business Name): JILL MARIE JAY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL MARIE BECKER FNP

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WILLOW ST
TYLER MN
56178-1201
US

IV. Provider business mailing address

1411 E COLLEGE DR
MARSHALL MN
56258-2086
US

V. Phone/Fax

Practice location:
  • Phone: 507-247-5521
  • Fax:
Mailing address:
  • Phone: 507-532-2264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13483
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13483
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: