Provider Demographics
NPI:1750024741
Name:KING, SCOTTY (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:SCOTTY
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:SCOTTY
Other - Middle Name:LUE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:OK
Mailing Address - Zip Code:73932-0640
Mailing Address - Country:US
Mailing Address - Phone:580-625-4551
Mailing Address - Fax:
Practice Address - Street 1:212 E 8TH ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:OK
Practice Address - Zip Code:73932-3184
Practice Address - Country:US
Practice Address - Phone:580-625-4551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207607207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine