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NPI Code Detail

MEDICARE: TERESA KING ANP, GNP, FNP

MEDICARE: TERESA KING ANP, GNP, FNP
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
1363L00000XNurse Practitioner146904MO
2363L00000XNurse Practitioner209-006077IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1209-006077OTHERILIL APN LICENSE
2041-330101OTHERILIL RN LICENSE

General Provider Information

NPI Number : 1841310968
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA KING ANP, GNP, FNP
Provider Business Mailing Address
First Line : 4974 MANCHESTER AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-2010
Country : US
Telephone Number : 314-289-6566
Fax Number : 314-289-6566
Provider Business Practice Location Address
First Line : 4974 MANCHESTER AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-2010
Country : US
Telephone Number : 314-289-6566
Fax Number : 314-289-6566
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2007
Last Update Date : 03/23/2012

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