Provider Demographics
NPI:1457653107
Name:KING, TAMARA LEIGH (CRNP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LEIGH
Last Name:KING
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:LEIGH
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:4704 WHITESBURG DR SW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1679
Mailing Address - Country:US
Mailing Address - Phone:256-213-1800
Mailing Address - Fax:256-429-9186
Practice Address - Street 1:4704 WHITESBURG DR SW
Practice Address - Street 2:SUITE 201
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1679
Practice Address - Country:US
Practice Address - Phone:256-213-1800
Practice Address - Fax:256-429-9186
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-101199363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL164230Medicaid
AL511-53712OtherBCBS
AL164618Medicaid
AL164252Medicaid
AL511-53710.OtherBCBS
AL102I500479OtherMEDICARE
AL511-53711OtherBCBS