Provider Demographics
NPI:1548593841
Name:KING, MARY P (RN, PHD, CPNP-PC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:P
Last Name:KING
Suffix:
Gender:F
Credentials:RN, PHD, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 PALO ALTO LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2941
Mailing Address - Country:US
Mailing Address - Phone:512-947-5128
Mailing Address - Fax:
Practice Address - Street 1:190 BUTTERCUP CREEK BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3772
Practice Address - Country:US
Practice Address - Phone:512-336-5824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX646818363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics