Individual
DUSTIN LARUE KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPNP-AC
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-8151
(601) 815-8152
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-8151
(601) 815-8152
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R875042
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
302I500886
MEDICARE PTAN
MS
Enumeration date
02/22/2011
Last updated
06/15/2012
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