Provider Demographics
NPI:1558882282
Name:KING, MARY JOAN (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JOAN
Last Name:KING
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JOAN
Other - Last Name:GREENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11416 GRIGSBY CHAPEL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1770
Mailing Address - Country:US
Mailing Address - Phone:865-392-1717
Mailing Address - Fax:865-392-1719
Practice Address - Street 1:11416 GRIGSBY CHAPEL RD STE 102
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1770
Practice Address - Country:US
Practice Address - Phone:865-392-1717
Practice Address - Fax:865-392-1719
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN157810163W00000X
TN23070363LF0000X
TNAPN23070363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse