Individual
MRS. JILL SUZANNE WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
742 MIDDLECREEK RD, SEVIERVILLE, TN 37862-5047
(865) 446-8835
Mailing address
917 SPRINGTIME TRL, SEYMOUR, TN 37865-3256
(865) 789-1595
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1193
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3663358
—
TN
01
—
4095095
BLUE CROSS
TN
01
—
P00285556
RRGA
TN
Enumeration date
06/12/2006
Last updated
01/26/2012
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