Provider Demographics
NPI:1891225421
Name:KING, VANESSA (FNP-C)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:VANESSA
Other - Middle Name:KING
Other - Last Name:ARISTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:COAHOMA
Mailing Address - State:TX
Mailing Address - Zip Code:79511-0745
Mailing Address - Country:US
Mailing Address - Phone:432-816-7074
Mailing Address - Fax:
Practice Address - Street 1:710 S GREGG ST
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-2425
Practice Address - Country:US
Practice Address - Phone:432-517-4692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134150363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily