Provider Demographics
NPI:1164053997
Name:KING, JILL A (BA RN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:KING
Suffix:
Gender:F
Credentials:BA RN
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:A
Other - Last Name:CROTEAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:390 RIVER STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-2226
Mailing Address - Country:US
Mailing Address - Phone:802-886-4500
Mailing Address - Fax:802-886-4560
Practice Address - Street 1:10 LINCOLN STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-2226
Practice Address - Country:US
Practice Address - Phone:802-885-7280
Practice Address - Fax:802-885-2683
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH063450-21163W00000X
VT026.0067527163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse