Provider Demographics
NPI:1417013608
Name:KING, KAREN (FNP)
Entity Type:Individual
Prefix:MISS
First Name:KAREN
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:MERLE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:21300 N JOHN WAYNE PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-8979
Mailing Address - Country:US
Mailing Address - Phone:520-494-7670
Mailing Address - Fax:520-494-7376
Practice Address - Street 1:21300 N JOHN WAYNE PARKWAY
Practice Address - Street 2:SUITE 110
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-8789
Practice Address - Country:US
Practice Address - Phone:520-494-7670
Practice Address - Fax:520-494-7376
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2526363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1275801326OtherMEDICARE NPI
AZ1417013608OtherNATIONAL INDIVIDUAL NPI (NPPES)
AZ659854Medicaid