Provider Demographics
NPI:1851408405
Name:KING, TAMMY L (C-FNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 MARKET RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-9445
Mailing Address - Country:US
Mailing Address - Phone:304-252-3900
Mailing Address - Fax:304-252-9311
Practice Address - Street 1:615 MARKET RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-9445
Practice Address - Country:US
Practice Address - Phone:304-252-3900
Practice Address - Fax:304-252-9311
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV49327363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7102069000Medicaid
WVP25742Medicare UPIN
WVP25742Medicare UPIN