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NPI Code Detail

MEDICARE: LYA KING PMHNP-BC

MEDICARE: LYA KING PMHNP-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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner95039006CA
2390200000XStudent in an Organized Health Care Education/Training ProgramCA

General Provider Information

NPI Number : 1609697127
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYA KING PMHNP-BC
Provider Business Mailing Address
First Line : 1082 MOUNT SHASTA RD
Second Line :
City : BIG BEAR CITY
State : CA
Zip : 92314-9441
Country : US
Telephone Number : 254-592-3146
Fax Number :
Provider Business Practice Location Address
First Line : 1891 EFFIE ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-1793
Country : US
Telephone Number : 323-644-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2024
Last Update Date : 05/19/2026

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Directions to “ LYA KING PMHNP-BC” Practice Location

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