Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 4082P | KY |
NPI | 1033189824 |
---|---|
Provider Name | Kimberly Suzanne King |
First Address | Somerset, KY 42503-2786 |
Second Address | Somerset, KY 42503-2786 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 17/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
78010006 | (05) | KY |