Provider Demographics
NPI:1346442472
Name:KING, AMY P (NP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:P
Last Name:KING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:PEARCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2790 GODWIN BLVD STE 360
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8153
Mailing Address - Country:US
Mailing Address - Phone:757-539-3911
Mailing Address - Fax:757-925-0615
Practice Address - Street 1:2790 GODWIN BLVD STE 360
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8153
Practice Address - Country:US
Practice Address - Phone:757-539-3911
Practice Address - Fax:757-925-0615
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167201363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1821133174Medicaid
VA0024167201OtherLICENSE
NC790259HMedicaid
VAC05064Medicare UPIN
NC790259HMedicaid