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NPI Code Detail

MEDICARE: KEVIN CHARLES KING APRN

MEDICARE:   KEVIN CHARLES 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
1363LF0000XFamily Nurse Practitioner12180CT

General Provider Information

NPI Number : 1285316885
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN CHARLES KING APRN
Provider Business Mailing Address
First Line : 380 MAIN ST
Second Line :
City : WATERTOWN
State : CT
Zip : 06795-2260
Country : US
Telephone Number : 860-274-8891
Fax Number :
Provider Business Practice Location Address
First Line : 380 MAIN ST
Second Line :
City : WATERTOWN
State : CT
Zip : 06795-2260
Country : US
Telephone Number : 860-274-8891
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2023
Last Update Date : 08/02/2023

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Directions to “ KEVIN CHARLES KING APRN” Practice Location

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