Healthcare Provider Details

I. General information

NPI: 1679412357
Provider Name (Legal Business Name): SAMANTHA KAY KING CNM, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 E DUPONT RD STE 105
FORT WAYNE IN
46825-0045
US

IV. Provider business mailing address

4014 FERNBANK DR
FORT WAYNE IN
46815-5410
US

V. Phone/Fax

Practice location:
  • Phone: 260-222-7401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number28250820A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: