Provider Demographics
NPI:1285266676
Name:KING, TERRA MICAH (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:TERRA
Middle Name:MICAH
Last Name:KING
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8794 MEADOWLARK CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH FULTON
Mailing Address - State:TN
Mailing Address - Zip Code:38257-7927
Mailing Address - Country:US
Mailing Address - Phone:270-627-0662
Mailing Address - Fax:
Practice Address - Street 1:710 CARL PERKINS PKWY
Practice Address - Street 2:
Practice Address - City:TIPTONVILLE
Practice Address - State:TN
Practice Address - Zip Code:38079-1678
Practice Address - Country:US
Practice Address - Phone:731-253-6690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27079363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care