Healthcare Provider Details

I. General information

NPI: 1134057979
Provider Name (Legal Business Name): ALICIA KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CABARRUS AVE E STE 200
CONCORD NC
28025-3781
US

IV. Provider business mailing address

2839 MOZART WAY
INDIANAPOLIS IN
46239-6928
US

V. Phone/Fax

Practice location:
  • Phone: 888-849-7379
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number28240421C
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: