Healthcare Provider Details

I. General information

NPI: 1275802084
Provider Name (Legal Business Name): INDEA B KING DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 MAIN ST
AMHERST NY
14226-3123
US

IV. Provider business mailing address

3610 MAIN ST STE B
AMHERST NY
14226-3123
US

V. Phone/Fax

Practice location:
  • Phone: 716-200-4122
  • Fax: 716-783-8825
Mailing address:
  • Phone: 716-815-4100
  • Fax: 716-217-5480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number336596
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number604720
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: