Healthcare Provider Details

I. General information

NPI: 1265441778
Provider Name (Legal Business Name): JILL KIO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N CAROL MALONE BLVD
GRAYSON KY
41143-1126
US

IV. Provider business mailing address

710 N CAROL MALONE BLVD
GRAYSON KY
41143-1126
US

V. Phone/Fax

Practice location:
  • Phone: 606-474-0669
  • Fax: 606-474-0376
Mailing address:
  • Phone: 606-474-0669
  • Fax: 606-474-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4760P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: