Provider Demographics
NPI:1881417947
Name:KING, JESSICA ANN (FNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:KING
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CONSTITUTION CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-4980
Mailing Address - Country:US
Mailing Address - Phone:585-734-2201
Mailing Address - Fax:
Practice Address - Street 1:1335 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2706
Practice Address - Country:US
Practice Address - Phone:585-504-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY355391207Q00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine