Healthcare Provider Details

I. General information

NPI: 1821507492
Provider Name (Legal Business Name): JILL M JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL KAPPLE

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MAIN ST
SUMMERSVILLE WV
26651-1343
US

IV. Provider business mailing address

32 PIONEER LN
SUMMERSVILLE WV
26651-1889
US

V. Phone/Fax

Practice location:
  • Phone: 304-872-1663
  • Fax:
Mailing address:
  • Phone: 681-224-0660
  • Fax: 304-718-5133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberPMHNP71327WV
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: