MEDICARE: PAULA MARIE KING FNP

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	363LF0000X	Family Nurse Practitioner	487	AK

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	:	1598745861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA MARIE KING FNP

Provider Business Mailing Address
First Line	:	90679 LEWIS ROAD
Second Line	:
City	:	WARRENTON
State	:	OR
Zip	:	97146
Country	:	US
Telephone Number	:	503-791-9801
Fax Number	:

Provider Business Practice Location Address
First Line	:	3680 NW SAMARITAN DRIVE
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97330-3737
Country	:	US
Telephone Number	:	541-754-1150
Fax Number	:	541-758-2693

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	07/08/2007

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