| Organization Name: | KINGS PSYCHIATRIC SERVICES LLC |
| NPI Number: | 1023449329 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLENE D KING (OWNER) |
| Mailing Address: | 713 Farmer St Port Gibson |
| State: | MS US |
| Postal Code: | 391502319 |
| Phone Number: | 6014485176 |
| Fax Number: | 6014485197 |
| NPI Enumeration Date: | 12/12/2013 |
| NPI Last Update Date: | 03/01/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | R8396684 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |