Provider Demographics
NPI:1679088850
Name:THUSTON, JILL (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:THUSTON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4056 SCOTT B DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-3564
Mailing Address - Country:US
Mailing Address - Phone:810-333-5133
Mailing Address - Fax:
Practice Address - Street 1:1501 KRAFFT RD
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3565
Practice Address - Country:US
Practice Address - Phone:810-985-5125
Practice Address - Fax:810-985-5127
Is Sole Proprietor?:No
Enumeration Date:2017-12-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704308747363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health