Provider Demographics
NPI:1609274232
Name:KING, PATRICIA MARIE SOUTH (DNP-FNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIE SOUTH
Last Name:KING
Suffix:
Gender:F
Credentials:DNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 PENINSULA RD
Mailing Address - Street 2:#641
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-4059
Mailing Address - Country:US
Mailing Address - Phone:901-605-1758
Mailing Address - Fax:
Practice Address - Street 1:3020 PENINSULA RD APT 641
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035-4075
Practice Address - Country:US
Practice Address - Phone:901-605-1758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-13
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23021363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily