Healthcare Provider Details

I. General information

NPI: 1003255746
Provider Name (Legal Business Name): JESSICA LYN KROL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2013
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 HATCHET MOUNTAIN RD
HOPE ME
04847-3057
US

IV. Provider business mailing address

400 CONGRESS STREET PO BOX 7577
PORTLAND ME
04101
US

V. Phone/Fax

Practice location:
  • Phone: 207-200-7319
  • Fax: 207-503-6070
Mailing address:
  • Phone: 207-200-7319
  • Fax: 207-503-6070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN64471
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberCNP211264
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: