Provider Demographics
NPI:1720733595
Name:KING, ALEXANDER W (AG-PCNP)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:W
Last Name:KING
Suffix:
Gender:M
Credentials:AG-PCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1221 LEE STREET
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0394
Practice Address - Country:US
Practice Address - Phone:349-242-7064
Practice Address - Fax:434-924-9068
Is Sole Proprietor?:No
Enumeration Date:2022-02-19
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00241836242084N0400X, 363LG0600X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology