Basic Information
| Provider Information | |||||||||
| NPI: | 1508928821 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2825 SIENA HEIGHTS DR | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890523976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026171227 | ||||||||
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| Practice Location | |||||||||
| Address1: | 324 T B STANLEY HWY | ||||||||
| Address2: | |||||||||
| City: | BASSETT | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240556108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766291076 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 04/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 73173 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QA0505X | 11798 | NV | N | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207Q00000X | 0101254878 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD-14790 | HI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QA0000X | 2005-00432 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0000277343 | 01 | HI | HMSA BILLING NUMBER | OTHER | 621385-02 | 05 | HI | MEDICAID |