Individual
THERESA RENEE KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, CFNP
Contact information
Practice address
427 HIGHWAY 51 N, BROOKHAVEN, MS 39601-2350
(601) 826-5500
(601) 420-5299
Mailing address
PO BOX 1805, BRANDON, MS 39043-1805
(601) 826-5500
(601) 420-5299
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R873560
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02572058
—
MS
Enumeration date
09/08/2006
Last updated
10/20/2015
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