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General NPI Number Information
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NPI Number | 1790134948
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Entity Type | Individual
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Provider Name | MR. CHARLES KING
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Gender | Male
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 826 KY 11 N
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City | BOONEVILLE
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State | KY
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Zip | 41314-9155
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Country | US
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Telephone | 606-593-6395
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Fax | 606-593-5916
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Provider Business Mailing Address
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Address Line | 122 WHISPERING HILLS DR
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City | BEREA
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State | KY
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Zip | 40403-9753
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Country | US
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Telephone | 859-625-2804
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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 | 3010331
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 3010331
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License Number State | KY
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