Provider Demographics
NPI:1740591437
Name:KING, KATHRYN L (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 W POPLAR AVE
Mailing Address - Street 2:STE 112
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-0618
Mailing Address - Country:US
Mailing Address - Phone:901-866-8372
Mailing Address - Fax:901-302-2372
Practice Address - Street 1:2028 W POPLAR AVE
Practice Address - Street 2:STE 112
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-0618
Practice Address - Country:US
Practice Address - Phone:901-866-8372
Practice Address - Fax:901-302-2372
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN88008363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1519558Medicaid
TN1031505009Medicare NSC