Provider Demographics
NPI:1366444580
Name:KING, TERESA L (NP-C)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9240 W UNION HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-8213
Mailing Address - Country:US
Mailing Address - Phone:623-583-7400
Mailing Address - Fax:623-583-7410
Practice Address - Street 1:9240 W UNION HILLS DR STE 100
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-8213
Practice Address - Country:US
Practice Address - Phone:623-583-7400
Practice Address - Fax:623-583-7410
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN071843363LA2200X
AZAP7148363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ 825903Medicaid
AZAZ 825903Medicaid