Healthcare Provider Details

I. General information

NPI: 1861842494
Provider Name (Legal Business Name): KASSIE KING ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 DOCTORS DR
PANAMA CITY FL
32405-4517
US

IV. Provider business mailing address

70 DOCTORS DR
PANAMA CITY FL
32405-4517
US

V. Phone/Fax

Practice location:
  • Phone: 850-785-1517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP9311462
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: