Provider Demographics
NPI:1952376832
Name:KING, ANGELA B (NP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:B
Last Name:KING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:B
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:655 SOUTH 7TH STREET BLDG 700/700A
Mailing Address - Street 2:78MDG/SGHC
Mailing Address - City:ROBINS AFB
Mailing Address - State:GA
Mailing Address - Zip Code:31098
Mailing Address - Country:US
Mailing Address - Phone:478-926-5095
Mailing Address - Fax:
Practice Address - Street 1:655 SOUTH 7TH STREET BLDG 700/700A
Practice Address - Street 2:78 MDG/SGHC
Practice Address - City:ROBINS AFB
Practice Address - State:GA
Practice Address - Zip Code:31098
Practice Address - Country:US
Practice Address - Phone:478-327-8019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN142732363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily