MEDICARE: ROBYN KING APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	124149	AR

General Provider Information

NPI Number	:	1083481501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBYN KING APRN

Provider Business Mailing Address
First Line	:	423 W HAWTHORN ST
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-1935
Country	:	US
Telephone Number	:	918-706-5610
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 W CENTER ST STE 200
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-6073
Country	:	US
Telephone Number	:	479-935-3076
Fax Number	:

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

Provider Enumeration Date	:	12/05/2023
Last Update Date	:	12/05/2023

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