Healthcare Provider Details

I. General information

NPI: 1346965167
Provider Name (Legal Business Name): JILL FAULKNER PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 COOPER AVE
MERCED CA
95348-4304
US

IV. Provider business mailing address

PO BOX 1858
MARIPOSA CA
95338-1858
US

V. Phone/Fax

Practice location:
  • Phone: 209-381-6665
  • Fax: 209-381-5901
Mailing address:
  • Phone: 209-769-6890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95014205
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number502631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: