Provider Demographics
NPI:1558685693
Name:KING, AMY BETH (NP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:BETH
Last Name:KING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 LELAND AVE
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-1224
Mailing Address - Country:US
Mailing Address - Phone:508-648-6195
Mailing Address - Fax:
Practice Address - Street 1:1467 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-2669
Practice Address - Country:US
Practice Address - Phone:978-249-9736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN272612363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology