Provider Demographics
NPI:1164560520
Name:KING, JONI GAIL (NP)
Entity Type:Individual
Prefix:MS
First Name:JONI
Middle Name:GAIL
Last Name:KING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17950 PRESTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5793
Mailing Address - Country:US
Mailing Address - Phone:972-354-5720
Mailing Address - Fax:972-354-5747
Practice Address - Street 1:9499 SHERIDAN BLVD
Practice Address - Street 2:SMARTCARE FAMILY MEDICAL CENTER
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-6532
Practice Address - Country:US
Practice Address - Phone:303-645-4362
Practice Address - Fax:303-645-4365
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO59639363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43503896Medicaid
CO808374Medicare Oscar/Certification
CO808374Medicare PIN
CO43503896Medicaid