Provider Demographics
NPI:1356096937
Name:KING, COURTNEY ANN (CNP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:KING
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-2812
Mailing Address - Country:US
Mailing Address - Phone:781-718-2239
Mailing Address - Fax:
Practice Address - Street 1:500 CUMMINGS CTR STE 4350
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6518
Practice Address - Country:US
Practice Address - Phone:978-532-2428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-13
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2277857363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily