Provider Demographics
NPI:1780279448
Name:KING, NIKOLAUS PERRY (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:NIKOLAUS
Middle Name:PERRY
Last Name:KING
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7640 WOLF RIVER CIR FL 2
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1744
Mailing Address - Country:US
Mailing Address - Phone:901-755-0208
Mailing Address - Fax:901-757-0208
Practice Address - Street 1:7640 WOLF RIVER CIR FL 2
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1744
Practice Address - Country:US
Practice Address - Phone:901-755-0208
Practice Address - Fax:901-757-0208
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29201363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care