Provider Demographics
NPI:1760025977
Name:KING, KEVIN ALLEN (FNP)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:ALLEN
Last Name:KING
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:ALLEN
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:1301 TATES CREEK RD APT SUITE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-5906
Mailing Address - Country:US
Mailing Address - Phone:361-222-5668
Mailing Address - Fax:
Practice Address - Street 1:1301 TATES CREEK RD APT SUITE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-5906
Practice Address - Country:US
Practice Address - Phone:361-222-5668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143881363LF0000X
TX788623163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency