Healthcare Provider Details

I. General information

NPI: 1962331405
Provider Name (Legal Business Name): RYAN KING PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 CHESTNUT RD
MYRTLE BEACH SC
29572-5502
US

IV. Provider business mailing address

2736 TEMPERANCE DR
MYRTLE BEACH SC
29577-1611
US

V. Phone/Fax

Practice location:
  • Phone: 843-945-1452
  • Fax:
Mailing address:
  • Phone: 843-331-5717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number31718
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: