Healthcare Provider Details

I. General information

NPI: 1760025977
Provider Name (Legal Business Name): KEVIN ALLEN KING FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KEVIN ALLEN KING FNP

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 TATES CREEK RD APT SUITE
CORPUS CHRISTI TX
78418-5906
US

IV. Provider business mailing address

1301 TATES CREEK RD APT SUITE
CORPUS CHRISTI TX
78418-5906
US

V. Phone/Fax

Practice location:
  • Phone: 361-222-5668
  • Fax:
Mailing address:
  • Phone: 361-222-5668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP143881
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number788623
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: