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General NPI Number Information
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NPI Number | 1528562899
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Entity Type | Individual
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Provider Name | KIMBERLY JO KING CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 209 W MAIN ST
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City | BOISE
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State | ID
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Zip | 83702
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Country | US
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Telephone | 208-608-6642
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Fax |
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Provider Business Mailing Address
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Address Line | 209 W MAIN ST
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City | BOISE
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State | ID
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Zip | 83702-7263
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Country | US
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Telephone | 208-608-6642
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | N-31500
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 58448
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License Number State | ID
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