MEDICARE: KRISTIN LYNN KING MSN, AGPCNP-BC

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	363LA2200X	Adult Health Nurse Practitioner	209011726	IL

General Provider Information

NPI Number	:	1508264292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN LYNN KING MSN, AGPCNP-BC

Provider Business Mailing Address
First Line	:	230 W MONROE ST
Second Line	:	SUITE 2540
City	:	CHICAGO
State	:	IL
Zip	:	60606-4703
Country	:	US
Telephone Number	:	847-313-5982
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 W MONROE ST
Second Line	:	SUITE 2540
City	:	CHICAGO
State	:	IL
Zip	:	60606-4703
Country	:	US
Telephone Number	:	847-313-5982
Fax Number	:

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

Provider Enumeration Date	:	12/11/2014
Last Update Date	:	11/18/2016

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