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NPI Code Detail

MEDICARE: TAMELA R. KING C-FNP

MEDICARE: TAMELA R. KING C-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
1363L00000XNurse Practitioner37484WV
2363L00000XNurse PractitionerCOA.05133-NPOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265439384
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMELA R. KING C-FNP
Provider Business Mailing Address
First Line : 305 N 5TH ST
Second Line :
City : IRONTON
State : OH
Zip : 45638-1578
Country : US
Telephone Number : 740-532-3534
Fax Number : 740-532-4859
Provider Business Practice Location Address
First Line : 10777 COUNTY ROAD 107
Second Line :
City : PROCTORVILLE
State : OH
Zip : 45669-8130
Country : US
Telephone Number : 740-302-0541
Fax Number : 740-867-0017
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2005
Last Update Date : 01/29/2018

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