Provider Demographics
NPI:1386724078
Name:KING, STEPHANIE MARION (FNP-C, DC)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MARION
Last Name:KING
Suffix:
Gender:F
Credentials:FNP-C, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 S 1000 E APT 706
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-3038
Mailing Address - Country:US
Mailing Address - Phone:626-379-2840
Mailing Address - Fax:626-799-2732
Practice Address - Street 1:1400 S FOOTHILL DR STE 101
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-2364
Practice Address - Country:US
Practice Address - Phone:626-379-2840
Practice Address - Fax:626-799-2732
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25070111N00000X
CA95111072163W00000X
UT11277278-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC25070Medicare UPIN
CADC25070Medicare UPIN