MEDICARE: JULIA ELIZABETH KING FNP-BC

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	363LF0000X	Family Nurse Practitioner	2025003934	MO

General Provider Information

NPI Number	:	1053116012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA ELIZABETH KING FNP-BC

Provider Business Mailing Address
First Line	:	4901 FOREST PARK AVE FL 3
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1495
Country	:	US
Telephone Number	:	314-362-1300
Fax Number	:	314-362-1482

Provider Business Practice Location Address
First Line	:	4901 FOREST PARK AVE FL 3
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1495
Country	:	US
Telephone Number	:	314-362-1300
Fax Number	:	314-362-1482

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

Provider Enumeration Date	:	02/14/2025
Last Update Date	:	02/02/2026

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