MEDICARE: MRS. MADELYN B KING NP

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	862819	MS

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	:	1861420978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MADELYN B KING NP

Provider Business Mailing Address
First Line	:	2323 5TH ST N
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2213
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2323 5TH ST N
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2213
Country	:	US
Telephone Number	:	662-368-1169
Fax Number	:	662-570-1492

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	08/28/2019

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