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MRS. CHARLENE DAVIS KING DNP, FPMHNP-BC

Psychiatric/Mental Health >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1104851161

Individual Registrant:
MRS. CHARLENE DAVIS KING DNP, FPMHNP-BC
Gender: F
Sole Proprietor

Location and contact information for practice:
713 FARMER ST  PORT GIBSON, MS 39150-2319 US
Tel: 601-448-5176  Fax: 601-448-5197

Contact information for business:
713 FARMER ST  PORT GIBSON, MS 39150-2319 US
Tel: 601-448-5176  Fax: 601-448-5197

Registration Information:
NPI: 1104851161
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LP0808XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Psychiatric/Mental Health
MSR839684

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
MEDICARE PTAN455325MS01
05207250MS05




HEALTH CARE JOBS MS - Page 1



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