Healthcare Provider Details

I. General information

NPI: 1891500567
Provider Name (Legal Business Name): JAMES MITCHELL KING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9067 POPLAR AVE STE 109
GERMANTOWN TN
38138-7851
US

IV. Provider business mailing address

9067 POPLAR AVE STE 109
GERMANTOWN TN
38138-7851
US

V. Phone/Fax

Practice location:
  • Phone: 901-522-6745
  • Fax:
Mailing address:
  • Phone: 901-522-6745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number40179
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: