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General NPI Number Information
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NPI Number | 1548103864
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Entity Type | Organization
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Legal Business Name | LEONIE KING LLC
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Dates
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Enumeration Date | 04/11/2026
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Last Update Date | 04/11/2026
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Provider Practice Location Address
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Address Line | 90 FORT WADE RD
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32081-5146
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Country | US
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Telephone | 757-842-0062
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Fax |
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Provider Business Mailing Address
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Address Line | 7643 GATE PKWY STE 104
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City | JACKSONVILLE
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State | FL
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Zip | 32256-2893
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Country | US
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Telephone | 757-842-0062
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LEONIE CICELY KING
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Credential | NP
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Telephone | 757-842-0062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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