Individual
MRS. CHARLENE DAVIS KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP, FPMHNP-BC
Contact information
Practice address
713 FARMER ST, PORT GIBSON, MS 39150-2319
(601) 448-5176
(601) 448-5197
Mailing address
713 FARMER ST, PORT GIBSON, MS 39150-2319
(601) 448-5176
(601) 448-5197
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R839684
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05207250
—
MS
01
—
455325
MEDICARE PTAN
MS
Enumeration date
07/11/2006
Last updated
01/22/2016
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