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General NPI Number Information
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NPI Number | 1538983291
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Entity Type | Individual
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Provider Name | CLARISSA RENEA KING MSN APRN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 101 PARK PL
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City | SELMA
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State | AL
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Zip | 36701-6764
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Country | US
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Telephone | 334-877-1490
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Fax |
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Provider Business Mailing Address
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Address Line | 508 ALABAMA AVE
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City | SELMA
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State | AL
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Zip | 36701-5807
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Country | US
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Telephone | 334-412-4854
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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 | 1-155646
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License Number State | AL
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