Healthcare Provider Details

I. General information

NPI: 1043804743
Provider Name (Legal Business Name): MARILYN LEE KING DNP FNP-BC PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 W BASELINE RD
MESA AZ
85202-9000
US

IV. Provider business mailing address

1855 W BASELINE RD
MESA AZ
85202-9000
US

V. Phone/Fax

Practice location:
  • Phone: 480-831-7566
  • Fax:
Mailing address:
  • Phone: 480-831-7566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRNP2623646
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRNP2623646
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN156754
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: