Healthcare Provider Details

I. General information

NPI: 1366821464
Provider Name (Legal Business Name): ASHLEY KING PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHIELDS AVE
DAVIS CA
95616-5270
US

IV. Provider business mailing address

1768 PONDEROSA DR
TRACY CA
95376-8203
US

V. Phone/Fax

Practice location:
  • Phone: 530-752-0871
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN261458
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95039929
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN261458
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95021934
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: