JERRY J KING (NPI# 1790754463) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790754463 |
| Entity Type | Individual |
| Full Name | JERRY J KING |
| Credential | PA-C |
| Practice Address |
2831 Fort Missoula Rd Suite 232 Missoula MT 59804-7419 |
| Practice Telephone | 4067286101 |
| Practice Fax Number | 4067213278 |
| Mailing Telephone | 4067286101 |
| Mailing Fax Number | 4067213278 |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
770597 | MT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MT | 0023283 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255506671 | Jerry N King | Surgery | 12731 S 83rd Ct, Palos Park, IL 60464-2026 | 2008-04-27 |
| 1346205689 | Jerry D King | Optometrist | 115 N Oak St, Eldon, MO 65026-1444 | 2006-04-19 |
| 1154465482 | Jerry Everett King | Radiology | 10180 Se Sunnyside Rd, Clackamas, OR 97015-8970 | 2007-02-19 |
| 1417020462 | Jerry Lee King | Optometrist | 103 W Loop 281, Ste 450, Longview, TX 75605-4653 | 2006-11-16 |
| 1538101845 | Jerry R King | Counselor | 12 Medical Dr, Amarillo, TX 79106-4136 | 2006-06-12 |
| 1669476396 | Jerry N King | Radiology | 4411 The 25 Way Ne, Ste 150, Albuquerque, NM 87109-5888 | 2005-06-10 |
| Street Address |
2831 FORT MISSOULA RD SUITE 232 |
| City | MISSOULA |
| State | MT |
| Zip Code | 59804-7419 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366449530 | Steven David Glow | Nurse Practitioner | 2831 Fort Missoula Rd, Missoula, MT 59804-7419 | 2005-07-03 |
| 1003363581 | Your Migraine Care Missoula LLC | Psychiatry & Neurology | 2831 Fort Missoula Rd, Ste 104, Missoula, MT 59804-7419 | 2016-09-01 |
| 1912359639 | Wahlberg Psychology Office, PC | Community/Behavioral Health | 2831 Fort Missoula Rd, Suite 201, Missoula, MT 59804-7419 | 2016-07-06 |
| 1881009892 | Andrea Dugan Skrocki | Nurse Practitioner | 2831 Fort Missoula Rd, Suite 206, Missoula, MT 59804-7419 | 2014-06-27 |
| 1548507171 | Meng Dentistry, Pllc | Dentist | 2831 Fort Missoula Rd, Suite 204, Missoula, MT 59804-7419 | 2013-01-16 |
| 1982968699 | Nicole A Swartz | Nurse Practitioner | 2831 Fort Missoula Rd, Suite 232, Missoula, MT 59804-7419 | 2012-06-27 |
| 1205192440 | Fugleberg Enterprises Inc | Audiologist | 2831 Fort Missoula Rd, Suite 300, Missoula, MT 59804-7419 | 2012-04-02 |
| 1194094672 | Meng Dentistry | Clinic/Center | 2831 Fort Missoula Rd, Suite 204, Missoula, MT 59804-7419 | 2011-12-29 |
| 1104155423 | Joseph Charles Meng | Dentist | 2831 Fort Missoula Rd, Physicians Center #2, Missoula, MT 59804-7419 | 2009-12-15 |
| 1942538897 | Duncan L Hubbard, Md, PC | Clinic/Center | 2831 Fort Missoula Rd, 304, Missoula, MT 59804-7419 | 2009-12-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063019297 | Momentum Speech Therapy, PC | Speech-Language Pathologist | 9885 O'brien Creek Road, Missoula, MT 59804 | 2020-10-01 |
| 1033633037 | Marissa Clark | Genetic Counselor, MS | 2827 Fort Missoula Rd., Suite 317, Missoula, MT 59804 | 2017-08-01 |
| 1104295245 | Scott Richter | Specialist/Technologist | 2892 Ringo Dr, Missoula, MT 59804 | 2015-09-18 |
| 1467860353 | Zachary Ueland | Pharmacist | 4000 Highway 93 South, Missoula, MT 59804 | 2014-07-24 |
| 1316378185 | Tracy Laurel Brothers | Counselor | 1305 Wyoming Street, Missoula, MT 59804 | 2013-12-04 |
| 1447683651 | Granite Pharmacy Missoula, LLC | Durable Medical Equipment & Medical Supplies | 2230 27th Ave. West, Suite 2, Missoula, MT 59804 | 2013-08-12 |
| 1871843953 | Autum Emerson Howell | Nurse Practitioner | 2831 Ft. Missoula Rd. Bldg 2, 102, Missoula, MT 59804 | 2012-09-14 |
| 1821353939 | Carlyn Doyle | Nurse Practitioner | 2835 Fort Missoula Rd Ste 203, Missoula, MT 59804 | 2012-07-05 |
| 1396011961 | Patricia Jean Evans | Internal Medicine | 702 S.w. Higgins, First Choice Medical Clinic, Missoula, MT 59804 | 2012-03-28 |
| 1205126794 | Pacific Medical, Inc. | Prosthetic/Orthotic Supplier | 2732 South Ave West, Suite 202, Missoula, MT 59804 | 2011-04-18 |
| Find all providers in zip 59804 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598965097 | Travis Lee Harris | Physician Assistant | 500 W. Broadway, Suite 320, St. Patrick Hospital, Missoula, MT 59802-4008 | 2007-07-23 |
| 1437541471 | Stephen Andrew Shepro | Physician Assistant | 2740 South Ave W Ste 101, Missoula, MT 59804-5137 | 2015-02-27 |
| 1427312438 | Jesse Jeffrey Doll | Physician Assistant | 2360 Mullan Rd, Ste C, Missoula, MT 59808-1811 | 2012-06-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457576407 | Rosalee Shorter | Physician Assistant | 341 Montana Hwy 135, Saint Regis, MT 59866-0176 | 2007-04-16 |
| 1245341874 | Tracy Edward Rogers | Physician Assistant | 202 Conway Dr Ste 200, Kalispell, MT 59901-3153 | 2006-08-31 |
| 1881604668 | Harley G Morrell | Physician Assistant | 2877 Overland Ave Ste C, Billings, MT 59102-7465 | 2006-08-08 |
| 1487644597 | Timothy J Devries | Physician Assistant | 111 Sunnyview Ln, Kalispell, MT 59901-3164 | 2005-10-28 |
| 1447802178 | Reid Merrill Gage | Physician Assistant | 801 N 29th St, Billings, MT 59101-0905 | 2019-07-12 |
| 1083192025 | Tyson Vanderby | Physician Assistant | 2675 Central Ave, Billings, MT 59102-6686 | 2018-08-01 |
| 1205384690 | Christine Moen | Physician Assistant | 2900 12th Ave N, Suite 355w, Billings, MT 59101-7506 | 2016-09-14 |
| 1174973564 | Jacob Wheeler | Physician Assistant | 925 Highland Blvd Ste 1100, Bozeman, MT 59715-6900 | 2016-06-15 |
| 1427414440 | Kara Haskell | Physician Assistant | 1450 Ellis St, #201, Bozeman, MT 59715 | 2016-01-06 |
| 1346642667 | Jennifer Vollmer | Physician Assistant | 1450 Ellis St Ste 201, Bozeman, MT 59715-8813 | 2014-09-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.