Provider Demographics
NPI:1265439384
Name:KING, TAMELA R (C-FNP)
Entity type:Individual
Prefix:
First Name:TAMELA
Middle Name:R
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 1:305 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1578
Mailing Address - Country:US
Mailing Address - Phone:740-532-3534
Mailing Address - Fax:740-532-4859
Practice Address - Street 1:10777 COUNTY ROAD 107
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-8130
Practice Address - Country:US
Practice Address - Phone:740-302-0541
Practice Address - Fax:740-867-0017
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV37484363L00000X
OHCOA.05133-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2315300Medicaid
WV7102062000Medicaid
KY78012846Medicaid
OH2033243Medicare PIN
WVP17012Medicare UPIN
WVNP06803Medicare PIN