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General NPI Number Information
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NPI Number | 1093286015
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Entity Type | Individual
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Provider Name | SHADARA KING AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 3214 CHARLES B ROOT WYND STE 203
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City | RALEIGH
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State | NC
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Zip | 27612-5440
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Country | US
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Telephone | 919-877-6800
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Fax | 844-881-7701
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Provider Business Mailing Address
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Address Line | 185 TIMBER WOLF XING
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City | GARNER
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State | NC
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Zip | 27529-9279
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Country | US
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Telephone | 302-228-6434
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Fax | 910-348-7961
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | LP-0010645
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 33592
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 27576
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3-001270
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License Number State | AL
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Taxonomy #5
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 5011293
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License Number State | NC
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Taxonomy #6
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AG03180040
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License Number State | GA
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Taxonomy #7
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5011293
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License Number State | NC
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