Basic Information
| Provider Information | |||||||||
| NPI: | 1437570504 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | LEANNE | ||||||||
| MiddleName: | RUTLEDGE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1895 HOFFMAN RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280546557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048618669 | ||||||||
| FaxNumber: | 7048655081 | ||||||||
| Practice Location | |||||||||
| Address1: | 1895 HOFFMAN RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280546557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048618669 | ||||||||
| FaxNumber: | 7048655081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2013 | ||||||||
| LastUpdateDate: | 04/24/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 167997 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 363LF0000X | 167997 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.