Healthcare Provider Details

I. General information

NPI: 1336340637
Provider Name (Legal Business Name): MELISSA MCGUINN KING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 MAR WALT DR
FORT WALTON BEACH FL
32547-6645
US

IV. Provider business mailing address

1024 MAR WALT DR
FORT WALTON BEACH FL
32547-6645
US

V. Phone/Fax

Practice location:
  • Phone: 850-863-3148
  • Fax: 850-863-3132
Mailing address:
  • Phone: 850-863-3148
  • Fax: 850-883-8517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0101238053
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: