Provider Demographics
NPI:1871295964
Name:BELT, JILLIAN KATHLEEN (FNP-C)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:KATHLEEN
Last Name:BELT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1089 JOHNS LOOP RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:KY
Mailing Address - Zip Code:42134-5362
Mailing Address - Country:US
Mailing Address - Phone:270-601-3119
Mailing Address - Fax:
Practice Address - Street 1:510 HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-9203
Practice Address - Country:US
Practice Address - Phone:615-672-3175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3019050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily