Provider Demographics
NPI:1275778433
Name:KING, LISA MARIE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:KING
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:LESHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:202 S GUADALUPE ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-5725
Mailing Address - Country:US
Mailing Address - Phone:575-234-1234
Mailing Address - Fax:575-234-1640
Practice Address - Street 1:202 S GUADALUPE ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5725
Practice Address - Country:US
Practice Address - Phone:575-234-1234
Practice Address - Fax:575-234-1640
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01636208M00000X, 363LF0000X
IN28145291A363LF0000X
IN71002855A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist