Provider Demographics
NPI:1043410665
Name:KING, LORETTA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12702 CORONA LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-4606
Mailing Address - Country:US
Mailing Address - Phone:832-372-1693
Mailing Address - Fax:281-879-7018
Practice Address - Street 1:2505 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9115
Practice Address - Country:US
Practice Address - Phone:713-739-7752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-21
Last Update Date:2007-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX623670363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily