Provider Demographics
NPI:1144052523
Name:STEVENS, JILLIAN (CMF)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 BROWN COVE RD
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-6898
Mailing Address - Country:US
Mailing Address - Phone:828-246-4754
Mailing Address - Fax:
Practice Address - Street 1:485 HENDERSONVILLE RD STE 3
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2700
Practice Address - Country:US
Practice Address - Phone:828-785-1881
Practice Address - Fax:828-785-1882
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC53470224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter