Provider Demographics
NPI:1821311937
Name:KING, REGINA SWIMS (RN)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:SWIMS
Last Name:KING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 WEST PARK AVE.
Mailing Address - Street 2:STE H
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930
Mailing Address - Country:US
Mailing Address - Phone:662-453-5348
Mailing Address - Fax:662-453-2112
Practice Address - Street 1:527 WEST PARK AVE.
Practice Address - Street 2:STE H
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930
Practice Address - Country:US
Practice Address - Phone:662-453-5348
Practice Address - Fax:662-453-2112
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS172163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse