MEDICARE: MRS. HOLLY LYNNE KING CMSRN BSN MSN

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	163WM0705X	Medical-Surgical Registered Nurse	549575	PA

General Provider Information

NPI Number	:	1740710409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLY LYNNE KING CMSRN BSN MSN

Provider Business Mailing Address
First Line	:	1517 BROADWAY AVE
Second Line	:
City	:	MC KEES ROCKS
State	:	PA
Zip	:	15136-1703
Country	:	US
Telephone Number	:	412-818-8080
Fax Number	:

Provider Business Practice Location Address
First Line	:	1517 BROADWAY AVE
Second Line	:
City	:	MC KEES ROCKS
State	:	PA
Zip	:	15136-1703
Country	:	US
Telephone Number	:	412-818-8080
Fax Number	:

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

Provider Enumeration Date	:	06/15/2017
Last Update Date	:	07/21/2022

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