Provider Demographics
NPI:1285079418
Name:KING, JOY J (AGPCNP-BC, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JOY
Middle Name:J
Last Name:KING
Suffix:
Gender:F
Credentials:AGPCNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37720 FOX RUN DR
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2523
Mailing Address - Country:US
Mailing Address - Phone:216-337-6321
Mailing Address - Fax:
Practice Address - Street 1:6803 MAYFIELD RD STE 500
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2215
Practice Address - Country:US
Practice Address - Phone:216-337-6321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14466-NP363L00000X
OH2012022366363L00000X
OH2021036544363LP0808X
OHAPRN.CNP.14466363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCS1502000123Medicaid
OH0106318Medicaid