Healthcare Provider Details

I. General information

NPI: 1386341311
Provider Name (Legal Business Name): KAMERON KING NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

738 N COLLEGE RD STE B
TWIN FALLS ID
83301-3386
US

IV. Provider business mailing address

738 N COLLEGE RD STE B
TWIN FALLS ID
83301-3386
US

V. Phone/Fax

Practice location:
  • Phone: 208-735-3600
  • Fax:
Mailing address:
  • Phone: 208-735-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number60809
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: