Provider Demographics
NPI:1942589551
Name:KING, JAMIE LEIGH (APN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEIGH
Last Name:KING
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:JANOWIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3300 W WILLOW KNOLLS DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-8121
Mailing Address - Country:US
Mailing Address - Phone:309-683-0200
Mailing Address - Fax:309-683-0201
Practice Address - Street 1:3300 W WILLOW KNOLLS DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-8121
Practice Address - Country:US
Practice Address - Phone:309-683-0200
Practice Address - Fax:309-683-0201
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104-36-4384363LW0102X
IL209009058363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health