Provider Demographics
NPI:1558554014
Name:KING, JANECIA LYNN (NP)
Entity type:Individual
Prefix:MRS
First Name:JANECIA
Middle Name:LYNN
Last Name:KING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:JANECIA
Other - Middle Name:LYNN
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, BC
Mailing Address - Street 1:2868 COMPTON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-2634
Mailing Address - Country:US
Mailing Address - Phone:513-712-8182
Mailing Address - Fax:513-880-0606
Practice Address - Street 1:2868 COMPTON RD STE 100
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-2634
Practice Address - Country:US
Practice Address - Phone:513-712-8182
Practice Address - Fax:513-880-0606
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.09517363LP0808X, 363LP0808X
OHCOA.09517-NP363LF0000X
OHCOA-095172084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2814191Medicaid