Healthcare Provider Details

I. General information

NPI: 1720806326
Provider Name (Legal Business Name): HOLLY BETH KING PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 S BRENTWOOD BLVD STE 209
BRENTWOOD MO
63144-1851
US

IV. Provider business mailing address

4801 WELDON SPRING PKWY # 300
WELDON SPRING MO
63304-9101
US

V. Phone/Fax

Practice location:
  • Phone: 636-949-5760
  • Fax: 866-440-9231
Mailing address:
  • Phone: 636-949-5760
  • Fax: 866-440-9231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG182051
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2024031590
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: