Individual
LARISA KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1901 ADAMS FARM PKWY, GREENSBORO, NC 27407-6338
(336) 722-7266
(336) 201-0538
Mailing address
713 S MARSHALL ST, WINSTON SALEM, NC 27101-5808
(336) 722-7266
(336) 201-0538
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
178286
NC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5012717
NC
Other
Enumeration date
01/03/2020
Last updated
08/31/2020
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