MEDICARE: DEBRACCA KING FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LC1500X	Community Health Nurse Practitioner	F02250361	NC
2	363LF0000X	Family Nurse Practitioner	F02250361	NC

General Provider Information

NPI Number	:	1003778580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRACCA KING FNP-C

Provider Business Mailing Address
First Line	:	5407 STRASBURG DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-6483
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1134 N ROAD ST
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3322
Country	:	US
Telephone Number	:	252-333-1047
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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