Provider Demographics
NPI:1578550547
Name:KING, JANET (RN NP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:RN NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 E 400 N
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-9460
Mailing Address - Country:US
Mailing Address - Phone:208-436-5842
Mailing Address - Fax:
Practice Address - Street 1:1024 8TH ST
Practice Address - Street 2:
Practice Address - City:RUPERT
Practice Address - State:ID
Practice Address - Zip Code:83350-1306
Practice Address - Country:US
Practice Address - Phone:208-436-0734
Practice Address - Fax:208-436-0735
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP67A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002546201Medicaid
ID002546201Medicaid
ID1341078Medicare ID - Type Unspecified