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General NPI Number Information
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NPI Number | 1417794280
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Entity Type | Individual
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Provider Name | GREGGY OLIVER KING
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Gender | Male
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Dates
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Enumeration Date | 07/10/2024
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 701 SHADOW LN STE 300
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City | LAS VEGAS
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State | NV
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Zip | 89106-4133
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Country | US
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Telephone | 702-383-1919
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Fax | 702-383-2283
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Provider Business Mailing Address
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Address Line | 1800 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89102-2386
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Country | US
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Telephone | 702-383-2620
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 880158
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License Number State | NV
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