MEDICARE: NIKITA ANN KING

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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1578315131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKITA ANN KING

Provider Business Mailing Address
First Line	:	22199 EAGLE VIEW DR
Second Line	:
City	:	DEERWOOD
State	:	MN
Zip	:	56444-6102
Country	:	US
Telephone Number	:	218-838-7211
Fax Number	:

Provider Business Practice Location Address
First Line	:	13205 ISLE DR
Second Line	:
City	:	BAXTER
State	:	MN
Zip	:	56425-8554
Country	:	US
Telephone Number	:	218-454-7600
Fax Number	:

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

Provider Enumeration Date	:	04/04/2024
Last Update Date	:	04/01/2026

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Directions to “ NIKITA ANN KING ” Practice Location

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