Provider Demographics
NPI:1083075758
Name:KING, MOIRA (APRN-CNP)
Entity Type:Individual
Prefix:MS
First Name:MOIRA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:MOIRA
Other - Middle Name:
Other - Last Name:HECKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE.
Mailing Address - Street 2:MLC 2023
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229
Mailing Address - Country:US
Mailing Address - Phone:513-636-4371
Mailing Address - Fax:513-636-7657
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:MLC 2023
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4371
Practice Address - Fax:513-636-7657
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.18621363L00000X
OHCOA.18621-NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0161909Medicaid