Basic Information
Provider Information
NPI: 1407462070
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KING
FirstName: LINDSEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: FNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 240 CAPITOL ST STE 500
Address2:  
City: CHARLESTON
State: WV
PostalCode: 253012297
CountryCode: US
TelephoneNumber: 3043441623
FaxNumber: 3043445853
Practice Location
Address1: 640 SANDHILL RD
Address2:  
City: POINT PLEASANT
State: WV
PostalCode: 255502163
CountryCode: US
TelephoneNumber: 3046755236
FaxNumber: 3043445853
Other Information
ProviderEnumerationDate: 09/19/2020
LastUpdateDate: 02/01/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/01/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X106900WVY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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