Provider Demographics
NPI:1477042745
Name:KING, MARY PHILLIPS (CRNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:PHILLIPS
Last Name:KING
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3608 MARY LN
Mailing Address - Street 2:
Mailing Address - City:FULTONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35068-1063
Mailing Address - Country:US
Mailing Address - Phone:205-542-2646
Mailing Address - Fax:205-971-7571
Practice Address - Street 1:3680 GRANDVIEW PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3411
Practice Address - Country:US
Practice Address - Phone:205-971-7500
Practice Address - Fax:205-971-7571
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-136738363LA2100X
ALCRNP-1-136738363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology