=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629931175
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARA KING
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2025
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1002 OSWEGO ST
-----------------------------------------------------
City | UTICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13502-5031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-927-2264
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1002 OSWEGO ST
-----------------------------------------------------
City | UTICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13502-5031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-927-2264
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | 562984-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------