Doctor Name: | LISA KING |
NPI Number: | 1043288806 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 076386 |
Business Practice Address: | 304 W Washington Ave Richland, MO - 655567101 |
Business Phone Number: | 5737655141 |
Business Fax Number: | 5737653824 |
Mailing Address: | 304 W Washington Ave, RICHLAND |
State: | MO |
Postal Code: | 655567101 |
Phone Number: | 5737655141 |
Fax Number: | 5737653824 |
NPI Enumeration Date: | 03/09/2006 |
NPI Last Update Date: | 08/03/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 076386 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |