Healthcare Provider Details

I. General information

NPI: 1255629416
Provider Name (Legal Business Name): KATHERINE JILLSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE HIRSCHEY

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 N MAYVIEW RD
RALEIGH NC
27607-4140
US

IV. Provider business mailing address

2709 N MAYVIEW RD
RALEIGH NC
27607-4140
US

V. Phone/Fax

Practice location:
  • Phone: 612-237-6212
  • Fax:
Mailing address:
  • Phone: 612-237-6212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number169919-3
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberJILL-BUGG2
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number361768
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number271
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: