Individual
MR. JODY L KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2800 VILLAGE WAY, TRENT WOODS, NC 28562-7305
(252) 637-7300
(252) 637-1772
Mailing address
2800 VILLAGE WAY, TRENT WOODS, NC 28562-7305
(252) 637-7300
(252) 637-1772
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-00274
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1036C
BLUE CROSS BLUE SHIELD
NC
05
—
891036C
—
NC
Enumeration date
11/04/2005
Last updated
05/19/2008
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