Provider Demographics
NPI:1740845528
Name:KING, KRISTEN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3755 ADMIRAL DR STE 105
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-1554
Mailing Address - Country:US
Mailing Address - Phone:336-673-5097
Mailing Address - Fax:336-203-3364
Practice Address - Street 1:3755 ADMIRAL DR STE 105
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-1554
Practice Address - Country:US
Practice Address - Phone:336-673-5097
Practice Address - Fax:336-217-8847
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25753363LP0808X
NC5011787363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health