Provider Demographics
NPI:1154860336
Name:KING, ALEASA MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ALEASA
Middle Name:MARIE
Last Name:KING
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ALEASA
Other - Middle Name:MARIE
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 TRUMBULL AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9403
Mailing Address - Country:US
Mailing Address - Phone:330-637-2000
Mailing Address - Fax:330-637-2001
Practice Address - Street 1:550 TRUMBULL AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9403
Practice Address - Country:US
Practice Address - Phone:330-637-2000
Practice Address - Fax:330-637-2001
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN372312363LF0000X
OHAPRN.CNP.020515363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0212509Medicaid
13985516OtherCAQH
OHCS1721200113OtherCARESOURCE