Provider Demographics
NPI:1770864894
Name:MORTON, JILL (PA-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MORTON
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 1:6850 HILLTOP RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-3576
Mailing Address - Country:US
Mailing Address - Phone:913-248-8008
Mailing Address - Fax:913-248-8668
Practice Address - Street 1:6850 HILLTOP RD
Practice Address - Street 2:SUITE 170
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-3576
Practice Address - Country:US
Practice Address - Phone:913-248-8008
Practice Address - Fax:913-248-8668
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01481363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant