Provider Demographics
NPI:1003835547
Name:KING, MELANIE ELAYNE (MSN, RN, NP-C)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:ELAYNE
Last Name:KING
Suffix:
Gender:F
Credentials:MSN, RN, NP-C
Other - Prefix:MS
Other - First Name:MELANIE
Other - Middle Name:ELAYNE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, RN, NP-C
Mailing Address - Street 1:2625 E DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1431
Mailing Address - Country:US
Mailing Address - Phone:559-443-2682
Mailing Address - Fax:559-443-2681
Practice Address - Street 1:2210 E ILLINOIS AVE STE 408
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2184
Practice Address - Country:US
Practice Address - Phone:559-443-2694
Practice Address - Fax:559-443-2696
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16412363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16412OtherNURSE PRACTITIONER FURNISHING