Provider Demographics
NPI:1275802084
Name:KING, INDEA B (FNP)
Entity Type:Individual
Prefix:
First Name:INDEA
Middle Name:B
Last Name:KING
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3123
Mailing Address - Country:US
Mailing Address - Phone:716-200-4122
Mailing Address - Fax:716-783-8825
Practice Address - Street 1:3610 MAIN ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-3123
Practice Address - Country:US
Practice Address - Phone:716-200-4122
Practice Address - Fax:716-783-8825
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY604720163W00000X
NY336596363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse