Provider Demographics
NPI:1073686929
Name:KING, ROBERT RANDALL (MSN FNP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:RANDALL
Last Name:KING
Suffix:
Gender:M
Credentials:MSN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:THROCKMORTON
Mailing Address - State:TX
Mailing Address - Zip Code:76483
Mailing Address - Country:US
Mailing Address - Phone:940-849-0629
Mailing Address - Fax:940-849-7141
Practice Address - Street 1:802 N MINTER AVE
Practice Address - Street 2:
Practice Address - City:THROCKMORTON
Practice Address - State:TX
Practice Address - Zip Code:76483
Practice Address - Country:US
Practice Address - Phone:940-849-2151
Practice Address - Fax:940-849-7141
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX572478 APN363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD0149091OtherDPS REG