Healthcare Provider Details

I. General information

NPI: 1013883206
Provider Name (Legal Business Name): JILLIAN IAMS PA-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILLIAN BLACKBURN

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 UNIVERSITY DR
WEST LIBERTY WV
26074-1082
US

IV. Provider business mailing address

993 OLD BRICK RD
WEST ALEXANDER PA
15376-2239
US

V. Phone/Fax

Practice location:
  • Phone: 304-336-5000
  • Fax:
Mailing address:
  • Phone: 304-559-7037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3261
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: