Provider Demographics
NPI:1568946150
Name:KING, KELLIE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 LINDSEY LN STE C
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-1725
Mailing Address - Country:US
Mailing Address - Phone:912-825-8488
Mailing Address - Fax:912-341-6794
Practice Address - Street 1:88 LINDSEY LN STE C
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-1725
Practice Address - Country:US
Practice Address - Phone:912-825-8488
Practice Address - Fax:912-341-6794
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA280313363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health