Provider Demographics
NPI:1053348607
Name:CALHOUN, JILL SUZANNE (PA-C)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:SUZANNE
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:SUZANNE
Other - Last Name:NIERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:738 BRYANT ST STE A
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-4189
Mailing Address - Country:US
Mailing Address - Phone:704-873-1189
Mailing Address - Fax:704-873-1116
Practice Address - Street 1:738 BRYANT ST STE A
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-4189
Practice Address - Country:US
Practice Address - Phone:704-873-1189
Practice Address - Fax:704-873-1116
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00156363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q51226Medicare UPIN
Q51226Medicare UPIN