Blackwill, Jessica

Blackwill, Jessica is an individual health care provider with primary practice located at 750 W D Ave , Kingman KS 67068-1266. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Blackwill, Jessica can be contacted via phone (620) 532-0295.

Contact Information

Primary practice address
750 W D Ave Kingman KS 67068-1266
Phone: (620) 532-0295
Fax: (855) 483-0002
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 13-131277-101 Kansas
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 53-78792-101 Kansas

Profile Details

NPI number 1114584802
LBN Legal business name Blackwill, Jessica
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date May 29th, 2019
Last updated Nov 8th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114584802 NPPES
Kansas MEDICAID 30003916630006
Kansas MEDICAID 201243020A

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