MEDICARE: GREGGY OLIVER KING

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	880158	NV

General Provider Information

NPI Number	:	1417794280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGGY OLIVER KING

Provider Business Mailing Address
First Line	:	1800 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2386
Country	:	US
Telephone Number	:	702-383-2620
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 SHADOW LN STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4133
Country	:	US
Telephone Number	:	702-383-1919
Fax Number	:	702-383-2283

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

Provider Enumeration Date	:	07/10/2024
Last Update Date	:	10/15/2025

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Directions to “ GREGGY OLIVER KING ” Practice Location

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