Provider Demographics
NPI:1750993481
Name:KING ALEXANDER, NIVA JAMICE (RN)
Entity type:Individual
Prefix:MRS
First Name:NIVA
Middle Name:JAMICE
Last Name:KING ALEXANDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:NIVA
Other - Middle Name:JAMICE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 974
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:MS
Mailing Address - Zip Code:39327-0974
Mailing Address - Country:US
Mailing Address - Phone:205-393-2327
Mailing Address - Fax:855-918-4758
Practice Address - Street 1:665 S PEAR ORCHARD ROAD
Practice Address - Street 2:SUITE 106 #553
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4859
Practice Address - Country:US
Practice Address - Phone:769-218-8891
Practice Address - Fax:855-918-4758
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-109693163WI0500X
MS898121163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy