Provider Demographics
NPI:1700127743
Name:KING, PAULINE JENNI (APN)
Entity Type:Individual
Prefix:MRS
First Name:PAULINE
Middle Name:JENNI
Last Name:KING
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 EUCALYPTUS CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-9639
Mailing Address - Country:US
Mailing Address - Phone:808-347-2839
Mailing Address - Fax:
Practice Address - Street 1:1206 S CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701
Practice Address - Country:US
Practice Address - Phone:775-445-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001493363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily