=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063045805
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JILLIAN PERRIER NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2020
-----------------------------------------------------
Last Update Date | 07/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2155 STATE ROUTE 22B
-----------------------------------------------------
City | MORRISONVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12962-3417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-563-8000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 320
-----------------------------------------------------
City | LYON MOUNTAIN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12952-0320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-822-0604
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | RN2279909
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | F403031
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------