MEDICARE: COURTNEY KING

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	174400000X	Specialist	SL010743	PA
2	363LF0000X	Family Nurse Practitioner	SP026602	PA

General Provider Information

NPI Number	:	1013273929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY KING

Provider Business Mailing Address
First Line	:	1026 E SYDNEY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-3423
Country	:	US
Telephone Number	:	484-548-0115
Fax Number	:

Provider Business Practice Location Address
First Line	:	1026 E SYDNEY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-3423
Country	:	US
Telephone Number	:	484-548-0115
Fax Number	:

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

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	05/16/2024

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Directions to “ COURTNEY KING ” Practice Location

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