Provider Demographics
NPI:1306616420
Name:KING, JEREMY ASHLEY
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:ASHLEY
Last Name:KING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 ASHTON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2486
Mailing Address - Country:US
Mailing Address - Phone:910-799-2262
Mailing Address - Fax:910-799-2943
Practice Address - Street 1:2800 ASHTON DR STE 200
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2486
Practice Address - Country:US
Practice Address - Phone:910-799-2262
Practice Address - Fax:910-799-2943
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant