Jill Marie King, RDN,LD,CDE
Individual provider Active NPI Registered Dietitian · Vernon, TX
NPI 1104488998 · NPPES record last updated Jul 2, 2019
Key facts
- NPI
- 1104488998
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- DT02529 (TX)
- Practice address
- 920 Hillcrest Dr
Vernon, TX 76384-3196 - Phone
- (940) 553-2862
- Fax
- (940) 553-2967
- NPI assigned
- Jul 2, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT02529 | TX | MD | Registered Dietitian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DT02529 | TX | Yes |
Addresses
Primary practice location
920 Hillcrest Dr
Vernon, TX 76384-3196
Mailing address
4208 Driftwood Dr
Wichita Falls, TX 76309-1011
Phone (940) 704-2853
Other providers in Vernon, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 2, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.