Provider Demographics
NPI:1255350625
Name:KING, BRENDA (NP)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:2600 GLASGOW AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5703
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:DERMATOLOGY
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:804-828-0300
Practice Address - Fax:804-560-8993
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2017-11-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024130834363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00372859OtherRR MEDICARE
VAP00372859OtherRR MEDICARE