| Doctor Name: | MRS. CHARLENE DAVIS KING |
| NPI Number: | 1104851161 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DNP, FPMHNP-BC |
| License Number: | R839684 |
| Business Practice Address: | 713 Farmer St Port Gibson, MS - 391502319 |
| Business Phone Number: | 6014485176 |
| Business Fax Number: | 6014485197 |
| Mailing Address: | 713 Farmer St, PORT GIBSON |
| State: | MS |
| Postal Code: | 391502319 |
| Phone Number: | 6014485176 |
| Fax Number: | 6014485197 |
| NPI Enumeration Date: | 07/11/2006 |
| NPI Last Update Date: | 01/22/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | R839684 |
| 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: | |