Individual
KATELYNN AMBERLY KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
480 FLOYD RD, SPARTANBURG, SC 29307-1518
(864) 582-2188
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
TL2724
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2935PA
—
SC
01
—
SCA1757628
MEDICARE PTAN
SC
Enumeration date
03/02/2017
Last updated
01/28/2021
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