MEDICARE: MAURA A KING PA-C

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	363AM0700X	Medical Physician Assistant	147692	MT
2	363A00000X	Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740916774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURA A KING PA-C

Provider Business Mailing Address
First Line	:	175 COMMONS LOOP SUITE 300
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901
Country	:	US
Telephone Number	:	406-756-7555
Fax Number	:	406-991-7984

Provider Business Practice Location Address
First Line	:	175 COMMONS LOOP SUITE 300
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901
Country	:	US
Telephone Number	:	406-756-7555
Fax Number	:	406-991-7984

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

Provider Enumeration Date	:	08/01/2022
Last Update Date	:	03/03/2026

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Directions to “ MAURA A KING PA-C” Practice Location

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