Provider Demographics
NPI:1346965167
Name:FAULKNER, JILL (PNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1858
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-1858
Mailing Address - Country:US
Mailing Address - Phone:209-769-6890
Mailing Address - Fax:
Practice Address - Street 1:2130 COOPER AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-4304
Practice Address - Country:US
Practice Address - Phone:209-381-6665
Practice Address - Fax:209-381-5901
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA502631163WS0200X
CA95014205363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WS0200XNursing Service ProvidersRegistered NurseSchool