MEDICARE: MS. PAMELA HELEN KING PMHNP, CNS BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	F400449-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124052527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA HELEN KING PMHNP, CNS BC

Provider Business Mailing Address
First Line	:	5757 DALTON DR
Second Line	:
City	:	FARMINGTON
State	:	NY
Zip	:	14425-9328
Country	:	US
Telephone Number	:	585-398-3575
Fax Number	:	585-388-8023

Provider Business Practice Location Address
First Line	:	1387 FAIRPORT RD
Second Line	:	BUILDING 600 SUITE 660
City	:	FAIRPORT
State	:	NY
Zip	:	14450-2003
Country	:	US
Telephone Number	:	585-388-8020
Fax Number	:	585-388-8023

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/08/2007

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