Provider Demographics
NPI:1457735136
Name:KING, VIRGINIA LEAH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LEAH
Last Name:KING
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:LEAH
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1511 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1000
Mailing Address - Country:US
Mailing Address - Phone:614-222-3525
Mailing Address - Fax:614-222-3608
Practice Address - Street 1:1511 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1000
Practice Address - Country:US
Practice Address - Phone:614-222-3525
Practice Address - Fax:614-222-3608
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.17442-NP363LF0000X
OHRN307513163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0143590Medicaid
OHH459240Medicare PIN