Healthcare Provider Details

I. General information

NPI: 1689031254
Provider Name (Legal Business Name): JILLYNN RACHELE HULL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S PINE ST
ELDON MO
65026-1581
US

IV. Provider business mailing address

PO BOX 777
RICHLAND MO
65556-0777
US

V. Phone/Fax

Practice location:
  • Phone: 573-836-7053
  • Fax:
Mailing address:
  • Phone: 573-765-5141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2016002420
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: