MEDICARE: PHILICIA J KING PMHNP-BC, FNP-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	363LF0000X	Family Nurse Practitioner	0024178413	VA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	65770	NM

General Provider Information

NPI Number	:	1528699675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILICIA J KING PMHNP-BC, FNP-BC

Provider Business Mailing Address
First Line	:	2930 HILLRISE DR STE 1
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4776
Country	:	US
Telephone Number	:	575-448-7119
Fax Number	:	575-205-0361

Provider Business Practice Location Address
First Line	:	2930 HILLRISE DR STE 1
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4776
Country	:	US
Telephone Number	:	575-448-7119
Fax Number	:	575-205-0361

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

Provider Enumeration Date	:	01/28/2020
Last Update Date	:	12/06/2025

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