Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 44852 | KS |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 44853 | KS |
N | 363LW0102X | Nurse Practitioner - Women's Health | 44853 | KS |
NPI | 1023058005 |
---|---|
Provider Name | Angela D King |
First Address | Wichita, KS 67212-6576 |
Second Address | Wichita, KS 67212-6576 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 29/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100354970A | (05) | KS |
S98309 | (02) |