Healthcare Provider Details

I. General information

NPI: 1609949817
Provider Name (Legal Business Name): JILL KRISTINE DOWELL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1363 W SPRUCE AVE
WASILLA AK
99654-5327
US

IV. Provider business mailing address

1363 W SPRUCE AVE
WASILLA AK
99654-5327
US

V. Phone/Fax

Practice location:
  • Phone: 907-376-2411
  • Fax: 907-352-3373
Mailing address:
  • Phone: 907-376-2411
  • Fax: 907-352-3373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP30006203
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1270
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierAP30006203
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerARNP
# 2
IdentifierRN00122578
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerREGISTERED NURSE
# 3
Identifier1270
Identifier TypeOTHER
Identifier StateAK
Identifier IssuerANP
# 4
Identifier9635277
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 5
Identifier33608
Identifier TypeOTHER
Identifier StateAK
Identifier IssuerRN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: