Basic Information
| Provider Information | |||||||||
| NPI: | 1528699675 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | PHILICIA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16463 DAHLGREN RD | ||||||||
| Address2: | |||||||||
| City: | KING GEORGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224855810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406449505 | ||||||||
| FaxNumber: | 5406449508 | ||||||||
| Practice Location | |||||||||
| Address1: | 16463 VA-206 | ||||||||
| Address2: | |||||||||
| City: | KING GEORGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406449505 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2020 | ||||||||
| LastUpdateDate: | 03/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0024178413 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.