Provider Demographics
NPI:1558905356
Name:KING, HAZEL ROSE (NP)
Entity Type:Individual
Prefix:
First Name:HAZEL
Middle Name:ROSE
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 1:1201A HILL RD
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78957-9533
Mailing Address - Country:US
Mailing Address - Phone:512-360-5272
Mailing Address - Fax:512-360-5273
Practice Address - Street 1:1201A HILL RD
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TX
Practice Address - Zip Code:78957-9533
Practice Address - Country:US
Practice Address - Phone:512-360-5272
Practice Address - Fax:512-360-5273
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142779363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology