Healthcare Provider Details

I. General information

NPI: 1588296842
Provider Name (Legal Business Name): KATHERINE ELIZABETH KING NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 09/21/2025
Certification Date: 09/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 MILITARY ST
PORT HURON MI
48060-5416
US

IV. Provider business mailing address

41033 HAMILTON DR
STERLING HEIGHTS MI
48313-3012
US

V. Phone/Fax

Practice location:
  • Phone: 810-488-8000
  • Fax:
Mailing address:
  • Phone: 586-925-6458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704311622
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: