Doctor Name: | LISA KING |
NPI Number: | 1588022784 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CRNP |
License Number: | 1-099065 |
Business Practice Address: | 8220 County Road 34 Dadeville, AL - 368534690 |
Business Phone Number: | 2563071848 |
Business Fax Number: | |
Mailing Address: | 8220 County Road 34, DADEVILLE |
State: | AL |
Postal Code: | 368534690 |
Phone Number: | 2563071848 |
Fax Number: | |
NPI Enumeration Date: | 02/02/2016 |
NPI Last Update Date: | 02/02/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 1-099065 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |