Organization
JUDITH A KING MN FNP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JUDITH A KING FAMILY NURSE PRACTIT (OWNER/PROVIDER)
(541) 474-5665
Entity
Organization
Contact information
Practice address
124 NW MIDLAND AVE, GRANTS PASS, OR 97526-1269
(541) 474-5665
(541) 474-4435
Mailing address
124 NW MIDLAND AVE STE 107, GRANTS PASS, OR 97526-1269
(541) 474-5665
(541) 474-4435
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
000037306N1
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
074450
—
OR
01
—
108613
MEDICARE ID-TYPE UNSPECIFIED
OR
01
—
900109622
MEDICARE RR
OR
01
—
R108613
MEDICARE
—
Enumeration date
10/29/2010
Last updated
12/14/2010
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