Individual provider · Type 1 NPI

Jesse Lilly

Student in an Organized Health Care Education/Training Program · Athens, WV

NPI number 1417588773 Active

Practice location

1000 Vermillion St
Athens, WV 24712-9027

Call (304) 322-6264 Map

Mailing address

251 Samaritan Dr
Shady Spring, WV 25918-8231

Specialties and licenses

TaxonomyCodeLicense
Athletic Trainer 2255A2300XNone listed
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1417588773

Jesse Lilly's National Provider Identifier is 1417588773, issued on Jan 27, 2020. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Athens, WV. The record was last updated on Jan 27, 2020.