MEDICARE: ALISA REBECCA KING CNM

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	367A00000X	Advanced Practice Midwife	1229494	TX

General Provider Information

NPI Number	:	1588512578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISA REBECCA KING CNM

Provider Business Mailing Address
First Line	:	4710 NE STALLINGS DR
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1615
Country	:	US
Telephone Number	:	936-560-2666
Fax Number	:	936-560-2681

Provider Business Practice Location Address
First Line	:	4710 NE STALLINGS DR
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1615
Country	:	US
Telephone Number	:	936-560-2666
Fax Number	:	936-560-2681

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

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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