Healthcare Provider Details

I. General information

NPI: 1407308596
Provider Name (Legal Business Name): JILL BUHRER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36065 SANTA FE AVE CARL R. DARNELL MEDICAL CENTER
FORT HOOD TX
76544
US

IV. Provider business mailing address

201 E. CENTRAL TEXAS EXPRESSWAY # 200
HARKER HEIGHTS TX
76548
US

V. Phone/Fax

Practice location:
  • Phone: 254-553-6227
  • Fax:
Mailing address:
  • Phone: 254-553-5901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1302364-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: