Provider Demographics
NPI:1821219114
Name:KING, KAYLEIGH (NP)
Entity Type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4611
Mailing Address - Country:US
Mailing Address - Phone:817-759-7000
Mailing Address - Fax:817-759-7027
Practice Address - Street 1:630 E STATE HIGHWAY 114
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-4410
Practice Address - Country:US
Practice Address - Phone:817-759-7000
Practice Address - Fax:817-759-7027
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX571115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159993804Medicaid
TX866N00OtherBCBS
TXD07564OtherPALMETTO RR
TX159993805Medicaid
TXP01005505OtherPALMETTO RR
TX159993803Medicaid
TX2035487-04Medicaid
TX0016SHOtherBCBS
TX1599938-08Medicaid
TX159993804Medicaid
TXTXB140062Medicare PIN
TX8L14349Medicare PIN
TX866N00OtherBCBS
TX8L14388Medicare PIN