Provider Demographics
NPI:1912012493
Name:COULTER, JILL A (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:A
Last Name:COULTER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 CLAY EDWARDS DR STE 240
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3254
Mailing Address - Country:US
Mailing Address - Phone:816-691-5287
Mailing Address - Fax:816-346-7690
Practice Address - Street 1:2113 SARNO RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3001
Practice Address - Country:US
Practice Address - Phone:321-676-0558
Practice Address - Fax:321-622-3588
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11018254363LF0000X
MO089219363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO540492501Medicaid
MO428757603Medicaid
MO10001688200OtherCOMMUNITY HOSPITAL