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General NPI Number Information
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NPI Number | 1649783754
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Entity Type | Individual
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Provider Name | MAXINE MILLICENT KING NP-C
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Gender | Female
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Dates
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Enumeration Date | 11/10/2017
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 700 RIVER DR
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City | FORT BRAGG
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State | CA
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Zip | 95437-5403
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Country | US
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Telephone | 707-961-4922
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Fax | 707-961-4921
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Provider Business Mailing Address
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Address Line | 700 RIVER DR
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City | FORT BRAGG
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State | CA
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Zip | 95437-5403
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Country | US
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Telephone | 707-961-4922
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Fax | 707-961-4921
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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 | AC003700
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | AC003700
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95028329
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 12634
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License Number State | CT
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