Provider Demographics
NPI:1225570617
Name:KING, LIBYA MICHELLE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:LIBYA
Middle Name:MICHELLE
Last Name:KING
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 COMMONS PARK LN
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-8925
Mailing Address - Country:US
Mailing Address - Phone:404-513-7214
Mailing Address - Fax:770-493-0532
Practice Address - Street 1:519 COMMONS PARK LN
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-8925
Practice Address - Country:US
Practice Address - Phone:404-513-7214
Practice Address - Fax:770-493-0532
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN206341363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily