Healthcare Provider Details

I. General information

NPI: 1053377572
Provider Name (Legal Business Name): ROSEMARY R KING APRN,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 N CENTRAL AVE STE 800
PHOENIX AZ
85012-2946
US

IV. Provider business mailing address

PO BOX 1299 215 W. SILVER SKY PLACE
GREEN VALLEY AZ
85622-1299
US

V. Phone/Fax

Practice location:
  • Phone: 602-345-2554
  • Fax:
Mailing address:
  • Phone: 520-400-3456
  • Fax: 520-648-0349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN027421
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberRN-027421
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: