Basic Information
| Provider Information | |||||||||
| NPI: | 1871160580 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | PRESTON | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP, CRNA. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 VICTORIA CT | ||||||||
| Address2: | |||||||||
| City: | ROSWELL | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882013492 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734291313 | ||||||||
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| Practice Location | |||||||||
| Address1: | 117 E 19TH ST | ||||||||
| Address2: | |||||||||
| City: | ROSWELL | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882015151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5756277000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2021 | ||||||||
| LastUpdateDate: | 06/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP3000X | 64064 | NM | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology | 207L00000X | 64064 | NM | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.