Basic Information
| Provider Information | |||||||||
| NPI: | 1003255746 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KROL | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | LYN | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 727 | ||||||||
| Address2: | |||||||||
| City: | WATERVILLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049030727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076609926 | ||||||||
| FaxNumber: | 2076609901 | ||||||||
| Practice Location | |||||||||
| Address1: | 24 GARDINER ST | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 043571347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077374359 | ||||||||
| FaxNumber: | 2077374412 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2013 | ||||||||
| LastUpdateDate: | 01/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | CNP211264 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 163WE0003X | RN64471 | ME | N | Nursing Service Providers | Registered Nurse | Emergency |
ID Information
| ID | Type | State | Issuer | Description | F06210742 | 01 | ME | AANP (FNP-BC) | OTHER | 2021015360 | 01 | ME | ANCC (FNP-C) | OTHER | CNP211264 | 01 | ME | MAINE STATE BOARD OF NURSING | OTHER |