Provider Demographics
NPI:1366839276
Name:KING, THARTA RENA
Entity Type:Individual
Prefix:
First Name:THARTA
Middle Name:RENA
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N ROBINSON ST
Mailing Address - Street 2:300
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4459
Mailing Address - Country:US
Mailing Address - Phone:804-367-3777
Mailing Address - Fax:
Practice Address - Street 1:110 N. ROBINSON STREET
Practice Address - Street 2:STE 300
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220
Practice Address - Country:US
Practice Address - Phone:804-367-3777
Practice Address - Fax:804-367-4209
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172537363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health