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General NPI Number Information
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NPI Number | 1336795616
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Entity Type | Individual
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Provider Name | JILL E KING FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/13/2019
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Last Update Date | 04/23/2020
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Provider Practice Location Address
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Address Line | 120 NE SAINT LUKES BLVD STE 220
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City | LEES SUMMIT
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State | MO
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Zip | 64086-6011
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Country | US
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Telephone | 816-932-7900
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Fax | 816-932-7920
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Provider Business Mailing Address
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Address Line | 901 E 104TH ST
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City | KANSAS CITY
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State | MO
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Zip | 64131-4517
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Country | US
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Telephone | 816-599-9499
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Fax | 816-932-9670
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2008003894
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F10191170
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License Number State | MO
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