Provider Demographics
NPI:1497934731
Name:POOL, JILL ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANN
Last Name:POOL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 SE QUAKERVALE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:KS
Mailing Address - Zip Code:66770-4185
Mailing Address - Country:US
Mailing Address - Phone:620-848-2300
Mailing Address - Fax:620-848-2301
Practice Address - Street 1:6610 SE QUAKERVALE RD
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:KS
Practice Address - Zip Code:66770-4185
Practice Address - Country:US
Practice Address - Phone:620-848-2300
Practice Address - Fax:620-848-2301
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01209363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200535880CMedicaid