Provider Demographics
NPI:1457478067
Name:KING, PAMELA F (CRNA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:F
Last Name:KING
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 HILL ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-4713
Mailing Address - Country:US
Mailing Address - Phone:318-442-8488
Mailing Address - Fax:318-442-8488
Practice Address - Street 1:2726 HILL ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-4713
Practice Address - Country:US
Practice Address - Phone:318-442-8488
Practice Address - Fax:318-442-8488
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO01660367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA59982Medicare ID - Type Unspecified