Provider Demographics
NPI:1326439555
Name:KING, CHARLETTE N (NP)
Entity Type:Individual
Prefix:
First Name:CHARLETTE
Middle Name:N
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 1:2865 MARINA SHORES DR
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451
Mailing Address - Country:US
Mailing Address - Phone:757-496-5000
Mailing Address - Fax:757-496-5000
Practice Address - Street 1:2865 LYNNHAVEN DR STE A4
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1542
Practice Address - Country:US
Practice Address - Phone:757-496-5000
Practice Address - Fax:757-496-5000
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165405363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0017137699OtherLICENSE