Provider Demographics
NPI:1013330109
Name:KING, TINA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 CAROLINA RD
Mailing Address - Street 2:
Mailing Address - City:NETTLETON
Mailing Address - State:MS
Mailing Address - Zip Code:38858-8144
Mailing Address - Country:US
Mailing Address - Phone:662-401-6207
Mailing Address - Fax:
Practice Address - Street 1:1573 MEDICAL PARK CIR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6580
Practice Address - Country:US
Practice Address - Phone:662-844-9885
Practice Address - Fax:662-842-1350
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR865718363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily