Individual
MR. JIMMY GLENN STILLWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA CERTIFIED REGIS
Contact information
Practice address
1007 S WILLIAMS, ATLANTA MEMORIAL HOSPITAL, ATLANTA, TX 75551
(903) 799-3000
Mailing address
8704 CR 317 SOUTH, HENDERSON, TX 75654
(903) 898-2662
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
TX RN 226622
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C81J
BLUE SHIELD GROUP
TX
01
—
81265U
BLUE SHIELD
TX
Enumeration date
10/26/2006
Last updated
07/09/2007
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