Provider Demographics
NPI:1295326148
Name:KING, SHARICKA (RN)
Entity type:Individual
Prefix:
First Name:SHARICKA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:SHARICKA
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 1132
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MS
Mailing Address - Zip Code:39069-1132
Mailing Address - Country:US
Mailing Address - Phone:601-597-1153
Mailing Address - Fax:
Practice Address - Street 1:5050 HWY 28
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MS
Practice Address - Zip Code:39069
Practice Address - Country:US
Practice Address - Phone:601-597-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS910129163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse