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General NPI Number Information
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NPI Number | 1629448154
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Entity Type | Individual
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Provider Name | KANDICE KING APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/27/2015
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Last Update Date | 09/27/2015
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Provider Practice Location Address
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Address Line | 2201 OLD SPANISH TRL
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City | WESTLAKE
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State | LA
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Zip | 70669-7800
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Country | US
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Telephone | 337-494-5150
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Fax |
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Provider Business Mailing Address
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Address Line | 3357 HIGHWAY 108 W
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City | SULPHUR
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State | LA
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Zip | 70665-8462
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP08500
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License Number State | LA
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