MEDICARE: ANN MARIE KING FNP

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	0105195	CO
2	363L00000X	Nurse Practitioner	96070	CO

General Provider Information

NPI Number	:	1104401157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN MARIE KING FNP

Provider Business Mailing Address
First Line	:	4069 S ODESSA ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80013-7481
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 E HARVARD AVE STE 570
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-7003
Country	:	US
Telephone Number	:	303-715-5020
Fax Number	:

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

Provider Enumeration Date	:	03/11/2021
Last Update Date	:	01/28/2022

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