MEDICARE: TIM KING CRNA

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	367500000X	Certified Registered Nurse Anesthetist	APN10298	TN
2	367500000X	Certified Registered Nurse Anesthetist	ARNP1627092	FL
3	367500000X	Certified Registered Nurse Anesthetist	AP112805	TX

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	:	1942244744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIM KING CRNA

Provider Business Mailing Address
First Line	:	PO BOX 782
Second Line	:
City	:	ALAMO
State	:	TX
Zip	:	78516-0782
Country	:	US
Telephone Number	:	865-599-6127
Fax Number	:

Provider Business Practice Location Address
First Line	:	2412 50TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79412-2504
Country	:	US
Telephone Number	:	806-744-7223
Fax Number	:	806-740-3325

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	09/12/2020

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Directions to “ TIM KING CRNA” Practice Location

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